Payor Reimbursement Analyst

Children's National Hospital Silver Spring, MD Full-time Administration / Clerical

Posted on March 18, 2023

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Payor Reimbursement Analyst - (220002EH)

Description

The Payor Reimbursement Analyst will support the financial sustainability of the organization through timely , accurate and thorough research of reimbursement issues related to Medicaid and Commercial payors. Responsible to track, trend and reconcile data and report to the Revenue Cycle. Develop and maintain collaborative relationships with payors, Access, Clinics, Managed Care, Business Operations, Leadership and Legal departments.

Qualifications

Minimum Education
BSN (Required)
Master's Degree (Preferred)

Minimum Work Experience
5 years Experience with 3 years of Utilization Review. (Required)

Required Skills/Knowledge
Ability to critically think and apply logic and reasoning to dynamically changing healthcare environment.
Requires superior verbal communication skills and service excellence approach with internal and external stakeholders.
Must have strong business writing skills.
Proficient at keyboarding and facile with Microsoft Office Excel, Access and Power Point.

Functional Accountabilities
Authorizations & Denials

Provide timely , comprehensive and accurate review of authorizations/denials to determine appropriate course of action.

Provide clear direction to others to resolve authorization/denial issues.

Provide timely appeals which are based on standardized criteria (Interqual and MCG) and follow appropriate escalation processes.

Monitor payor response to appeals to ensure timely claim payment or write-off.

Function as a subject matter expert for CRM, Revenue Cycle and the organization.

Data Management

Tracks, trends and analyzes all authorization issues and denials by payor utilizing relevant software.

Report data on a weekly, monthly , quarterly or yearly basis as requested to report out to Revenue Cycle.

Propose process improvements for a variety of stakeholders based on data analysis to mitigate future denials.

Communication/Collaboration

Communicate and collaborate with internal and external partners to optimize reimbursement.

Actively participate in payor meetings to contribute to Children's discussion of Authorization and Denials data and trends.

Develops cogent, comprehensive appeals utilizing standardized criteria or evidence.

Education

Contribute to the education of CRM, Medical and other hospital staff about authorization and denials.

Based on authorization and denial patterns, develops and implements an educational plan for various staff roles.

Organizational Accountabilities
Organizational Commitment/Identification

Partner in the mission and upholds the core principles of the organization

Committed to diversity and recognizes value of cultural ethnic differences

Demonstrate personal and professional integrity

Maintain confidentiality at all times

Customer Service

Anticipate and responds to customer needs; follows up until needs are met

Teamwork/Communication

Demonstrate collaborative and respectful behavior

Partner with all team members to achieve goals

Receptive to others’ ideas and opinions

Performance Improvement/Problem-solving

Contribute to a positive work environment

Demonstrate flexibility and willingness to change

Identify opportunities to improve clinical and administrative processes

Make appropriate decisions, using sound judgment

Cost Management/Financial Responsibility

Use resources efficiently

Search for less costly ways of doing things

Safety

Speak up when team members appear to exhibit unsafe behavior or performance

Continuously validate and verify information needed for decision making or documentation

Stop in the face of uncertainty and takes time to resolve the situation

Demonstrate accurate, clear and timely verbal and written communication

Actively promote safety for patients, families, visitors and co-workers

Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance

Primary Location

: Maryland-Silver Spring

Work Locations

Dorchester

12200 Plum Orchard Dr

Silver Spring 20904

Job

: Nursing

Organization

: Finance

Position Status: R (Regular) - FT - Full-Time

Shift: Day

Work Schedule: M-F

Job Posting

: Mar 14, 2023, 8:27:18 PM

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Payor Reimbursement Analyst

Description

Qualifications

Primary Location

Work Locations

Job

Organization

Job Posting

Children's National Hospital

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