Healthcare Payment Compliance Analyst

University Radiology•East Brunswick Township, NJ

3d•Onsite

About The Position

University Radiology, the largest provider of subspecialty radiology and teleradiology services in NJ, is comprised of over 200 Board Certified radiologists with advanced U.S.-based training and expertise in all modalities and all subspecialty areas. In operation for more than 60 years, University Radiology staffs, manages and provides preliminary and final subspecialty interpretations and consultative support for hospitals, imaging centers and other medical facilities, and serves as the academic radiology faculty at Rutgers Robert Wood Johnson Medical School. Our physicians interpret over 2.1 million radiology procedures per year. University Radiology has a unique full-time opportunity in our East Brunswick, NJ Business office for a Heathcare Payment Compliance Analayst to play a key role in safeguarding compliance and optimizing financial performance within the University Radiology Group enterprise. As a Revenue Payment Compliance Analyst, you will bring expertise in billing, charge capture, and knowledge of regulatory standards to ensure accurate, efficient, and compliant revenue practices. This is an opportunity to work collaboratively with clinical, financial, and operational teams while serving as a subject matter expert in revenue cycle compliance and charge capture processes.

Requirements

Minimum of 5 years of experience in payment review / contract compliance or revenue cycle management, with a strong understanding of both Office based and Professional claims processes.
Previous experience in a role that involved analyzing contracts, escalating issues, and working with legal teams or insurance plans.
Strong analytical skills with the ability to identify trends and root causes of non-compliance.
Knowledge of CPT, HCPCS, CMS, and commercial payer reimbursement methodologies.
Strong organizational, and interpersonal skills including excellent communication skills, both written and verbal, with the ability to create clear, concise reports and summaries.
Ability to work independently and manage multiple priorities in a fast-paced environment.
Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) and familiarity with healthcare billing systems.
Deep understanding of the revenue cycle, office based and professional claims processes, and related regulations.
Familiarity with payer contract terms, claims processing, and healthcare reimbursement.
Experience in working with insurance plans and an understanding of claim adjudication processes.

Nice To Haves

Bachelor degree in a Finance areas or Healthcare is strongly preferred.

Responsibilities

Identify any payment variances comparing contracted fee schedules to actual reimbursement.
Assess for over or underpayment variances and report to PFS leadership.
Responsible for the maintenance of the URG Charge master.
Responsible for the maintenance of all Payer Fee schedules used in the Revenue Cycle billing processes.
Assure all fee schedules are accurate and up to date at all times.
Review any fee schedule changes based on newly negotiated rates, annual CMS adjustments, new CPT or HCPCS codes.
Assure all supply codes are reviewed and up to date with respect to billable supply charges that would include Radiopharmaceuticals, contrast and other supplies.
Working with PFS leadership, review and resolve charge capture issues, ensuring accuracy, timeliness, and compliance with CMS, Third party payer and internal guidelines.
Identify and summarize payer payment variances and coordinate payment projects directly with the payer working directly with the PFS and Managed Care departments and provide monthly status reports by developing detailed summaries of claims and issues that need to be escalated to insurance providers or legal entities for resolution.
Meet with payers to discuss submitted projects, conducting follow-up to ensure agreed-upon corrections are implemented, and validating the outcomes.
Conduct revenue integrity analyses to identify trends, risks, and opportunities for improvement.
Support audits, compliance reviews, and policy updates related to charge capture and billing integrity.
Provide training and consultative support to departments on charging policies and compliant practices, as needed.
Develop reports and recommendations to inform leadership on potential payment compliance risks and revenue opportunities.
Contribute to system enhancements, workflow redesigns, and strategic initiatives to optimize reimbursement.
Quantify cumulative identified revenue improvements on a monthly basis and report to leadership.