Claims Analyst TC

Brown Medicine

1d•$21 - $35•Hybrid

About The Position

SUMMARY: The Claims Analyst reports to the Supervisor Claims Administration Follow-up. Under general direction and within established Brown University Health policies and procedures, performs all duties necessary to ensure all projects, ad-hoc reports and Governmental reporting requirements are processed accurately and within mandated time frames to ensure a positive reimbursement impact. Takes appropriate steps to review, identify and reduce issues resulting from project research related to Accounts Receivable follow-up activities for Brown University Health Corporate Services and its affiliates. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate RESPONSIBILITIES: Consistently applies the corporate values of respect, honesty and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly, geographically accessible and high-value services within the environment of a comprehensive integrated academic health system. Is responsible for knowing and acting in accordance with the principles of the Brown University Health Corporate Compliance Program and Code of Conduct. Assists the Supervisors and Claim Director in compiling any necessary statistics needed for follow-up activities. Ensures timely and accurate processing of adjustments and denials from payers. Initiates action to resolve accounts. Meets with payers, Denials Management Staff and PFS staff as necessary to resolve disputes related to accounts receivable. Processes all necessary online adjustments or changes as needed, such as adding/deleting insurance information, insurance priority changes, balance transfers, demographic changes, contractual allowances, any other routine patient accounting adjustment not requiring supervisor approval. Continually evaluates work flow and identifies opportunities to improve process for full and complete payment for all hospital services rendered to patients. Ensures accuracy, efficiency and integrity of all information systems pertaining to Government payers as well as Blue Cross and Worker's compensation. Researches payer issues resulting in payment delays, denials, underpayments and processing deficiencies and recommends changes as appropriate. Responds to requests from various hospital personnel related to Medicare or Medicaid regulations as it applies to hospital and professional billing and reimbursement providing supporting resource information. Ensures Medicare and Medicaid 838 and 3 day overlap reports are accurately completed as required by federal regulation to ensure no interruption to Medicare and Medicaid monies paid to each affiliate. Reviews recommendations of write offs from Claims Administration Follow-Up Representatives to ensure all steps have been taken to ensure accuracy and may refer back to staff or forward on to supervisor. Ensures all shared interdepartmental accounts receivable related files are completed accurately and referred to the appropriate department to ensure timely claims processing. Creates, generates and maintains ad hoc reports as requested by Supervisor or Director to assist in the daily operation of the department. Coordinates all assigned activities between Brown University Health and its Contracted Billing Agency for Out of State Medicaid billing and accounts receivable. Participates in staff meetings, councils, quality improvement teams and other such meetings and committees as required. Develops and maintains working relationship with Brown University Health affiliate departments as needed to ensure fully data exchange. Responsible for completing spreadsheets needed to respond to internal and external audits. Maintains up to date knowledge of changes in regulations that impact claims processing Performs other duties as necessary. WORK LOCATIONS/EXPECTIONS: After orientation at the Corporate facilities, work is performed based on the following options approved by management and with adherence to a signed telecommuting work agreement and Patient Financial Services Remote Access Policy and Procedure. Full time schedule worked in office Full time schedule worked in a dedicated space in the home Part time schedule in office and in a dedicated space within the home Schedules must be approved in advance by management who will allow for flexibility that does not interfere with the ability to accomplish all job functions within the said schedule. Staff are required to participate in scheduled meetings and be available to management throughout their scheduled hours. Staff must be signed into Microsoft Teams during their entire shift and communicate with Supervisor as directed. MINIMUM QUALIFICATIONS: BASIC KNOWLEDGE: Associate's degree in accounting, business office practices, computer science or other related area or equivalent experience. EXPERIENCE: Three year's experience in patient accounting. Experience should demonstrate thorough knowledge of claims administration in similarly complex healthcare organization. Must be familiar with ICD-9/10, CPT-4 coding, UB04 and HCFA 1500 claims administration. Ability to perform financial analysis. Comprehensive knowledge of patient accounting activities in an automated, networked, multiple hospital environment. Detailed knowledge of regulatory requirements INDEPENDENT ACTION: Incumbent functions independently within scope of department policies and practices; refers specific problems to supervisor only when clarification of departmental policies and procedures may be required. SUPERVISORY RESPONSIBILITIES: None. Pay Range: $20.96-$34.61 EEO Statement: Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment. Location: Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903 Work Type: M-F 7:00am-3:30pm Work Shift: Day Daily Hours: 8 hours Driving Required: No As Rhode Island's largest health system and private employer, Brown University Health is the state's premier provider of health services and includes the only Level I Trauma Center for southeastern New England. Today, more than 20,000 people work at Brown University Health and bring their unique skills, experiences, and compassion to their jobs every day. Formed in 1994, Brown University Health is a not-for-profit health system based in Providence, RI comprising three teaching hospitals of The Warren Alpert Medical School of Brown University: Rhode Island Hospital and its Hasbro Children's; The Miriam Hospital; and Bradley Hospital, the nation’s first psychiatric hospital for children; Newport Hospital, Saint Anne's Hospital and Morton Hospital, community hospitals offering a broad range of health services; Gateway Healthcare, the state’s largest provider of community behavioral health care; and Brown Health Medical Group, the largest multi-specialty practice in Rhode Island. Brown University Health is an equal opportunity employer that values diversity of cultural background, race, gender, age, religion, identity, ability, and perspectives - we are actively committed to a diverse workforce that represents the patients and community that we serve. We are invested in creating a respectful, inclusive, and equitable environment that supports the holistic well-being of our employees and their families. Join us and help build a healthier future for our patients - and for yourself. Company Location Belonging and Engagement Nursing Our Mission

Requirements

Associate's degree in accounting, business office practices, computer science or other related area or equivalent experience.
Three year's experience in patient accounting.
Experience should demonstrate thorough knowledge of claims administration in similarly complex healthcare organization.
Must be familiar with ICD-9/10, CPT-4 coding, UB04 and HCFA 1500 claims administration.
Ability to perform financial analysis.
Comprehensive knowledge of patient accounting activities in an automated, networked, multiple hospital environment.
Detailed knowledge of regulatory requirements

Responsibilities

Consistently applies the corporate values of respect, honesty and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly, geographically accessible and high-value services within the environment of a comprehensive integrated academic health system.
Is responsible for knowing and acting in accordance with the principles of the Brown University Health Corporate Compliance Program and Code of Conduct.
Assists the Supervisors and Claim Director in compiling any necessary statistics needed for follow-up activities.
Ensures timely and accurate processing of adjustments and denials from payers.
Initiates action to resolve accounts.
Meets with payers, Denials Management Staff and PFS staff as necessary to resolve disputes related to accounts receivable.
Processes all necessary online adjustments or changes as needed, such as adding/deleting insurance information, insurance priority changes, balance transfers, demographic changes, contractual allowances, any other routine patient accounting adjustment not requiring supervisor approval.
Continually evaluates work flow and identifies opportunities to improve process for full and complete payment for all hospital services rendered to patients.
Ensures accuracy, efficiency and integrity of all information systems pertaining to Government payers as well as Blue Cross and Worker's compensation.
Researches payer issues resulting in payment delays, denials, underpayments and processing deficiencies and recommends changes as appropriate.
Responds to requests from various hospital personnel related to Medicare or Medicaid regulations as it applies to hospital and professional billing and reimbursement providing supporting resource information.
Ensures Medicare and Medicaid 838 and 3 day overlap reports are accurately completed as required by federal regulation to ensure no interruption to Medicare and Medicaid monies paid to each affiliate.
Reviews recommendations of write offs from Claims Administration Follow-Up Representatives to ensure all steps have been taken to ensure accuracy and may refer back to staff or forward on to supervisor.
Ensures all shared interdepartmental accounts receivable related files are completed accurately and referred to the appropriate department to ensure timely claims processing.
Creates, generates and maintains ad hoc reports as requested by Supervisor or Director to assist in the daily operation of the department.
Coordinates all assigned activities between Brown University Health and its Contracted Billing Agency for Out of State Medicaid billing and accounts receivable.
Participates in staff meetings, councils, quality improvement teams and other such meetings and committees as required.
Develops and maintains working relationship with Brown University Health affiliate departments as needed to ensure fully data exchange.
Responsible for completing spreadsheets needed to respond to internal and external audits.
Maintains up to date knowledge of changes in regulations that impact claims processing
Performs other duties as necessary.