Revenue Cycle Reimbursement Analyst 1

Mercyhealth Wisconsin and Illinois

7d•$21 - $32

About The Position

Essential Duties and Responsibilities Interpret and understand coverage and benefit limitations by having a comprehensive understanding of benefits and state requirements for multiple markets. Identify trends and suggest and develop efficiencies in the revenue cycle through review and trending of payer contracts and reimbursement trends. Research and trends denials from payors. Reads through healthcare contracts and contract language and ensures proper contract workflows. Researches remittances and Explanation of Benefits (EOBs) for complete accurate payments or denials. Work with payers to understand specific reasons for variances and/or denials and measures to prevent future denials. Research payer policies and requirements and utilize knowledge to determine whether an appeal is required and to get claims overturned. Develop sound and well-supported appeal arguments, where an appeal is warranted. Submits corrected claims and appeals. Coordinates appeals with clinical or coding areas within the revenue cycle. Requests appropriate adjustments, when required. Provide training and guidance to team members on market specific issues by providing feedback to management on claims and provider issues, and updating client business rules. Partner with Reimbursements team to assist in completing all other tasks as necessary to ensure accurate and timely internal turnaround times. Culture of Excellence Behavior Expectations To perform the job successfully, an individual should demonstrate the following behavior expectations: Quality - Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals. Service - Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions. Partnering - Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals. Cost - Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue. Mercyhealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or protected veteran status. Mercyhealth offers competitive pay and a comprehensive benefits package including: Medical, Dental, Vision Life & Disability Insurance FSA/HSA Options Generous, accruing paid time off Paid Parental and caregiver leave Career advancement and educational opportunities Tuition and certification reimbursement Certification Reimbursement Well-being Programs Employee Discounts On-Demand Pay Financial Education Annual recognition/awards events Partner appreciation days Family entertainment/attractions discount Community service/improvement opportunities Click here for more details regarding Mercyhealth Careers Benefit Information. At Mercyhealth, we don’t simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin. Mercyhealth has been nationally recognized for our commitment to our people and culture, including: #1 in the nation on AARP's Best Employers for Workers Over 50 One of Working Mother magazine's 100 Best Companies for Working Mothers A Top 50 Company and Top 10 Nonprofit for Executive Women For over 135 years, Mercyhealth has provided high-quality health care to residents throughout northern Illinois and southern Wisconsin. We have a passion for providing comprehensive health care close to home for area residents through our six hospitals and 85 primary and specialty care locations. As an integrated health system, you can come to us for routine health care, like annual physicals, immunizations and preventive health screenings, as well as highly specialized care, such as neonatal intensive care, heart surgery, stroke care, neurosurgery, cancer treatment and much more. The range of Mercyhealth's specialties and the skills of our doctors, nurses and clinical staff are truly extraordinary.

Requirements

Associate's degree in finance, business, or healthcare administration and 3 years' experience working in revenue cycle, denials management and contract management required.
5 years of experience in lieu of degree.
Knowledge of healthcare reimbursement programs, coding, and billing preferred.

Responsibilities

Interpret and understand coverage and benefit limitations by having a comprehensive understanding of benefits and state requirements for multiple markets.
Identify trends and suggest and develop efficiencies in the revenue cycle through review and trending of payer contracts and reimbursement trends.
Research and trends denials from payors.
Reads through healthcare contracts and contract language and ensures proper contract workflows.
Researches remittances and Explanation of Benefits (EOBs) for complete accurate payments or denials.
Work with payers to understand specific reasons for variances and/or denials and measures to prevent future denials.
Research payer policies and requirements and utilize knowledge to determine whether an appeal is required and to get claims overturned.
Develop sound and well-supported appeal arguments, where an appeal is warranted.
Submits corrected claims and appeals.
Coordinates appeals with clinical or coding areas within the revenue cycle.
Requests appropriate adjustments, when required.
Provide training and guidance to team members on market specific issues by providing feedback to management on claims and provider issues, and updating client business rules.
Partner with Reimbursements team to assist in completing all other tasks as necessary to ensure accurate and timely internal turnaround times.