Reimbursement Analyst - PFS Sharp Foundation Models - Sharp Corporate - Day Shift - Full Time

Sharp HealthCare•San Diego, CA

2d•$37 - $53

About The Position

To provide coding support and appeal guidance relating to reimbursement issues. Research and propose recommended action on policies and regulations to enable Sharp HealthCare entities to obtain the highest possible reimbursement. To act as a liaison between PFS Business Office Staff and Regulatory Compliance department. Utilize the payer contract tool to report payer trends.

Requirements

5 Years Experience with coding, auditing and patient account follow up in a business office
Certified Professional Coder (CPC) - AAPC -REQUIRED

Nice To Haves

Bachelor's Degree

Responsibilities

Customer service
System Integration: Ensures timely coding and reimbursement tools are supplied to physicians, peers and subordinates. This position serves as a resource for staff to have outstanding accounts reviewed for documentation supported by coding reviewed in order to perform timely follow-up collections and claim form submissions.
Demonstrates effective customer relations by: Consistently communicate with Executives, Operations Senior Management, department members and other Sharp employees in a pleasant, professional and effective manner. Respond appropriately to needs, preferences and dissatisfactions expressed by customers within a time period appropriate to the request. Maintain confidentiality. Ensure effective, customer-focused operations of responsible areas. Provide effective consultation and support services to Executives, Operation Senior Management, to assist in strategic and operational planning and facilitate achievement of organizational and departmental goals. Assist in analyzing and interpreting trends and variances requiring Manager Business Service and/or Manager of Quality control's attention.
Leadership Assessment Rating by Manager of Business Service and Manager Quality Control/Peers: Provides effective leadership of the position, including properly motivating peers, ensuring optimum levels of productivity, reengineering workloads, etc.
Financial: Ensures entity-specific quantitative and qualitative analyses are completed and communicated. Provide educational lectures on regulatory changes to CCD staff when required.
Quality Documents and updates system usages related policies and procedures. Reviews System capabilities to ensure user functionality and satisfaction in accordance with corporate goals and objectives. Coordinates and/or assists the medical group in the establishment of correct coding tools for compliant billing and reimbursement. Investigate user problems; perform troubleshooting activities and communicates resolution to the affected parties. Provide coding and reimbursement analysis PFS/CCD and medical group.
Reimbursement and appeals Coding Guidelines and Tools for Reimbursement: Responsible for the planning, coordination and accumulation of documentation for the preparation of meaningful, accurate and timely appeals and the quantitative and qualitative analyses and supporting documentation thereto.
Reopenings & Appeals: Responsible for the planning, coordination and accumulation of documentation for reopening items or appeal issues the Manager of the Business Office and or Quality requests. Provide documentation timely and accurately so that the reopenings or appeals meet all filing deadlines.
System integration Demonstrates effective customer relations by: Consistent communication with Physicians, Operations Staff, Management, department members and other Sharp employees in a professional and effective manner; responds appropriately and timely to needs, preferences and dissatisfaction expressed by customers. Ensures effective, customer-focused operations; analyzes and evaluates the rejection volume of fee for service reimbursement.
Training and compliance Effectiveness: Recommend and assist with the implementation of techniques to improve productivity, increase efficiencies, reduce costs, and maintain state of the art practices. Ensure compliance with corporate policies, keep abreast of current trends in healthcare, accept interpersonal differences, respecting others values and opinions and promoting cooperation, effectively prioritizing workload to meet required deadlines and setting goals and objectives in conjunction with the manager. Offer ongoing training and consulting to customers. Participate in all meetings related to coding and compliance.