Healthcare Financial Senior Analyst

Medical Equation, Inc.•West Lake Hills, TX

1d•Onsite

About The Position

The Healthcare Financial Senior Analyst provides leadership and support for the Bill Review Team by acting as a subject matter expert, training new team members, creating and maintaining team processes and procedures, assisting team members to resolve problems, and modeling a positive attitude and work ethic. This role involves reviewing medical billing and clinical medical records for documented services, correct coding and billing, and preparing comparative data analysis and written reports.

Requirements

Demonstrated experience communicating effectively and providing expert-level customer service.
Knowledge of payment mechanisms and ability to research as needed.
Knowledge of conducting and reporting on comparative analyses in the field of healthcare finance.
Knowledge of medical coding and billing; CPT and HCPCS billing and claims processing.
Knowledge of payment contract elements.
Knowledge of a variety of medical service types and how they get paid; Propensity to learn payment rules for hospital inpatient/outpatient services, ambulatory surgical center services, physician office services, pharmacy, DME, ambulance, rehab, etc.
Knowledge of CMS, Workers Comp and billing charge indexes or propensity to learn them.
Knowledge of analyzing ratios of charges to benchmarks.
Knowledge of consolidating billing and valuation data and writing reports to explain the valuation of a provider's charges so that a judge and jury can understand.

Nice To Haves

College Degree and industry certification preferred.

Responsibilities

Ensure all team members are trained on the Bill Review process and guidelines.
Creates and/or maintains a standard operating procedure (SOP) booklet or file to ensure process integrity is maintained throughout personnel turnover and shortages.
Deconflict situations between team members or with a client.
Reviews clinical medical records for supporting documentation of billed charges.
Provides coding review feedback to medical bill review expert witness consultants.
Uses medical services valuation methods and benchmarks to determine reasonable value of services provided and analyzes future surgical cost estimates and life care plans.
Provides written reports thoroughly explaining the reasonable value analysis.
Contributes thoughtfully to a growing team of professionals who respect each other and promote each other in providing a unique and significant service to our healthcare system.
Continuously monitors, reviews, and refines internal processes within the Bill Review Team to maximize efficiency, quality, and client satisfaction.
Assists team members in finding solutions to problems and ensure information flow between teams, raising concerns to the Department Director or Manager as needed.
Maintain professionalism and adhere to all Medical Equation policies.
Additional duties, responsibilities and projects as assigned.