Billing and Insurance Specialist Job In Troy, Michigan
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Senior Payor Reimbursement Analyst
U.S. Medical Management (USMM) is an affiliate of a leading Fortune 100 company. A national organization built on a continuum of care with premier healthcare providers, clinicians and patient focused individuals working together. Our Mission – “Through Compassionate Patient-Centered Care in the Home; We will Provide Exceptional Outcomes across our Continuum of Services” – Visiting Physicians Association, Pinnacle Senior Care, Grace Hospice, Comfort Hospice, Home DME & our In Home Health Assessments (IHA).
Our Values of Integrity, Respect, Teamwork & Excellence are leading us to a better tomorrow for patient care. Our Purposes Centered on “We are Unified in our Work through our Continuum of Services” “We can Find Comfort that We are Making a Difference for our Patients” & “We make a Broader Positive Impact on Society”, allows USMM to be poised for a phenomenal future.
We are seeking candidates who desire the experience of delivering quality & compassionate healthcare within proven care models with patients at the forefront of everything we do.
Benefits We Have to Offer:
- Health, Dental, Vision, Disability & Life Insurance
- 401K Retirement Plan
- Paid Holidays
- Flexible Spending Account
- Tuition Reimbursement
The Senior Payor Reimbursement Analyst will be responsible for all aspects of payor reimbursement analysis within the Revenue Cycle umbrella. This will include, but is not limited to, close collaboration with billing & reimbursement, credentialing & enrollment, revenue cycle reporting and internal payor contracting. The Senior Reimbursement Analyst requires a strong knowledge of payor contract language and reimbursement methodologies, along with organizational skills.
Essential Duties and Responsibilities
- Verification of payor rate schedule updates for compliance to contract terms, including identifying rate schedule underpayments
- Educate and communicate payor methodology and/or rate changes to the appropriate internal entities and/or department staff
- Proactively identify revenue generating opportunities or risks, by reviewing reimbursement rates and corresponding write offs to determine profitability per payor
- Prepares financial payor models and benchmark comparisons to support contractual decisions including assumptions, observations, conclusions and recommendations, such as do not take lists
- Assist in optimizing processes related to payor management by using our EMRs in the most effective ways
- Responsible for ensuring a standardized payor setup up process within the EMRs
- Gatekeeper of maintaining the list of system administrators for payor sites and revenue cycle systems
- Main point of contact for assisting in one time contract agreements
- Maintain a payor matrix by service line with key contract terms to assist with the management of revenue cycle operations
- Develop and maintain effective relationships through effective and timely communication
- Takes initiative and action to respond, resolve, and follow up on all issues in a timely manner
- Work directly and in strong collaboration with Operations and other revenue cycle departments
- Perform miscellaneous job related duties as assigned.
REQUIRED Knowledge, Skills and Experience
- Associate’s Degree in Business, Accounting, Finance, or healthcare related field
- Ten years of experience in a Revenue Cycle work environment, healthcare managed care, health care insurance provider contracting, or medical or financial analysis
- Comprehensive understanding of healthcare terminology, insurance contract language and payment methodologies, including a good understanding of Medicare and Medicaid reimbursement
- Ability to decipher key performance indicator (KPI) trends and communicate opportunity areas to department leaders
- Analyze and manipulate large data sets
- Must possess both strong analytical and written/verbal skillsets
- Proficient in Microsoft Office, including Outlook, Word, Excel, and PowerPoint
- Skilled in organizing different resources and establishing priorities
- Effective communicator with the ability to partner with shared stakeholders to achieve mutual success
Preferred Knowledge, Skills and Experience
- Bachelor degree in business, finance, accounting, health care
- 5 years of steadily advancing leadership roles
With more than 2000 employees across the country, USMM promotes an environment that is rooted in supporting the home-based, patient centered care that our family of companies provides.