Reimbursement Analyst, Full-Time

Community Hospital•Grand Junction, CO

2d•Onsite

About The Position

The Compliance Reimbursement Auditor is a full-time position responsible for ensuring proper reimbursement for Oncology services. This role involves coordinating with internal and external parties, reviewing payments and denials, managing appeals, and staying updated on coding practices. The analyst will act as a Subject Matter Expert for research billing compliance, collaborate with the Financial Services team, and define processes to ensure quality and efficiency in billing and reimbursement practices. This position also serves as a liaison for billing-related inquiries and concerns.

Requirements

High school diploma or equivalent.
At least 5 years of inpatient/outpatient coding experience OR equivalent combination of education and experience.
Certification in one of the following organizations is required: AHIMA, AAPC (RHIT and/or CCS,)
ACRP / SOCRA certification within 6 months of being eligible (SOCRA is preferred).

Nice To Haves

Bachelor’s degree in Science, healthcare or related field preferred.
SOCRA certification is preferred.

Responsibilities

Coordinate with internal departments and external facilities to determine the appropriate payor for services.
Review payments received for Oncology services to ensure proper reimbursement from payers.
Review all Oncology/Research related denials and coordinate appeals with the appropriate Business Office Team/s.
Review and update current HCPCS codes as they relate to Oncology.
Participate in hospital-wide coding and charge master meetings.
Act as a Subject Matter Expert and provide internal monitoring to ensure research billing compliance.
Collaborate closely with the Financial Services team for final coding and billing.
Provide CPT codes for all study procedures billable to sponsor, patient, and/or Insurance.
Manage and communicate Medicare Coverage Analysis for GVO Clinical Trials.
Define and improve processes to ensure quality and efficiency.
Collaborate with the Research Team for Sponsor Billing.
Implement policies and processes for internal and external workflows to ensure compliant, quality, and efficient practices related to Oncology and Research Billing and Reimbursement.
Act as a liaison for any Oncology or Research billing questions, changes, and/or concerns.
Escalate Oncology or Research billing questions, changes, and/or concerns appropriately.
Verify determinations of whether proposed clinical research studies are a qualifying clinical trial as defined by Medicare Clinical Trial Policy.