Payer Compliance Analyst, Full time - Days

University of Chicago Medicine•Burr Ridge, IL

11d•Remote

About The Position

Be a part of a world-class academic healthcare system, UChicago Medicine as a Payer Compliance Analyst for our Revenue Cycle Improv Department. This position will be primarily a work from home opportunity with the requirement to come onsite as needed. You may be based outside of the greater Chicagoland area. The Payer Compliance Analyst leads the payer compliance monitoring and reimbursement integrity for the UChicago Medicine (UCM) Revenue Cycle for contracted fee-for-service payers including Commercial payers, International payers, Medicare Advantage payers and Medicaid MCO payers by conducting payment variance analyses, monitoring expected reimbursement against payment activity, and preparing reports and analyses to inform revenue cycle and Office of Manage Care (OMC) leadership of payer compliance issues that do not conform to contractual terms. Essential Job Functions Provide support for any payer compliance documentation needed for possible dispute resolution processes with payers including mediation, arbitration and other legal actions including court proceedings. Lead the revenue cycle teams in monitoring and enforcement of payer reimbursement compliance including account receivable (AR) variances related to UM issues, requests for information, audits, denials, underpayments and no pays. Maintain a detailed electronic tracking system of all payer compliance issues and claims for tracking, trending and resolution. Collaborates with various staff (e.g. AR follow-up team, UM, charge and code auditors, revenue integrity, quality auditors, underpay analysts, OMC contractors, etc.) to compile worklists and trends that highlight payer compliance issues Support the revenue cycle and OMC through active participation in monthly payer joint operating committee (JOC) meetings and payer operational meetings including creation of agenda items, tracking reports and payer dashboard/trending reports with the lead role in payer accountability and follow-up on action items for remediation and resolution. Drive the meeting discussion for escalation of high level issues to identify and rectify pattern issues and root causes contributing to payer contract compliance with the goal to remediate and resolve outstanding payer issues and improve AR and cash flow. from Medicare for additional information. Zero billing-Must satisfy HCFA’s requirement to submit MSP claims when no balance is due. Develop and maintain strong relationships with payer counterparts to ensure the expedited and efficient resolution to payer compliance issues. Develop Payer Dashboard reports that track and trend issues by payer and provide executive level overviews for internal leadership teams and payer teams. Provide revenue cycle and OMC with feedback on issues to be addressed in contract negotiations; including payer policies, market and national payment trends, operational and claims concerns and data/analysis to strengthen our negotiating position. Use Epic and FinThrive to understand and monitor contractual terms and expected reimbursement to monitor payment activity and trends to inform business intelligence and identify pattern issues for remediation and resolution. Continued education on ever-changing reimbursement rules and policy updates both commercial and governmental payers that impact expected reimbursement and payments and provide education to internal stakeholders on reimbursement terms, methodologies and impacts as needed

Requirements

Bachelor's degree in business, finance, health or public administration, management, related field, or equivalent work experience.
Requires a minimum of seven (7) or more years of related health care experience in revenue cycle, claims and financial analysis and contract enforcement with a record of successfully completing similar duties, demonstrating considerable knowledge of health care organizations, insurance companies, operations, finance, and managed care.
Strong knowledge base of hospital and physician revenue cycle operations required.
Detailed knowledge of hospital, physician and ancillary complex reimbursement methodologies including experience with governmental programs related to Medicare, Medicaid managed care and Medicare Advantage highly desirable
Excellent understanding of contract language and rate terms, physician and hospital coding and billing, claims forms and claim payment methodologies, payer EOBs, and insurance laws.

Nice To Haves

Experience in a multi-facility health system, large academic medical center, or insurer environment highly desirable.
Highly prefer extensive familiarity with the Illinois provider and payer market and competitive landscape and demonstrated experience and success in building and maintaining positive relationships with payer partners.
Direct experience performing trend/variance analyses and working with providers and third party payers to facilitate issue resolution.
Familiarity and aptitude with some form of contract management and/or cost accounting systems for use in data gathering and model analysis highly desirable.

Responsibilities

Provide support for any payer compliance documentation needed for possible dispute resolution processes with payers including mediation, arbitration and other legal actions including court proceedings.
Lead the revenue cycle teams in monitoring and enforcement of payer reimbursement compliance including account receivable (AR) variances related to UM issues, requests for information, audits, denials, underpayments and no pays.
Maintain a detailed electronic tracking system of all payer compliance issues and claims for tracking, trending and resolution.
Collaborates with various staff (e.g. AR follow-up team, UM, charge and code auditors, revenue integrity, quality auditors, underpay analysts, OMC contractors, etc.) to compile worklists and trends that highlight payer compliance issues
Support the revenue cycle and OMC through active participation in monthly payer joint operating committee (JOC) meetings and payer operational meetings including creation of agenda items, tracking reports and payer dashboard/trending reports with the lead role in payer accountability and follow-up on action items for remediation and resolution.
Drive the meeting discussion for escalation of high level issues to identify and rectify pattern issues and root causes contributing to payer contract compliance with the goal to remediate and resolve outstanding payer issues and improve AR and cash flow.
from Medicare for additional information. Zero billing-Must satisfy HCFA’s requirement to submit MSP claims when no balance is due.
Develop and maintain strong relationships with payer counterparts to ensure the expedited and efficient resolution to payer compliance issues.
Develop Payer Dashboard reports that track and trend issues by payer and provide executive level overviews for internal leadership teams and payer teams.
Provide revenue cycle and OMC with feedback on issues to be addressed in contract negotiations; including payer policies, market and national payment trends, operational and claims concerns and data/analysis to strengthen our negotiating position.
Use Epic and FinThrive to understand and monitor contractual terms and expected reimbursement to monitor payment activity and trends to inform business intelligence and identify pattern issues for remediation and resolution.
Continued education on ever-changing reimbursement rules and policy updates both commercial and governmental payers that impact expected reimbursement and payments and provide education to internal stakeholders on reimbursement terms, methodologies and impacts as needed