Bachelor’s Degree in Business Administration or related field, or the equivalent combination of education and/or experience required.
Five years analytical and financial experience in the healthcare setting, with demonstrated ability. Must be able to prioritize workload on a daily basis.
Extensive knowledge of all medical insurances, third party payer rules, regulations, coding and reimbursement guidelines, along with hospital Revenue Cycle policies and procedures, is needed.
Must possess strong analytical and interpretive skills, with a propensity for thoroughness and attention to detail. Must be able to prepare and present analyses and reports, and formulate recommendations and participate in Revenue Cycle process improvement development in a compliant manner based on the analysis.
Must have a working knowledge of Huron reporting systems, Microsoft and McKesson Patient Financial Services systems and software, including PCON. Ability to pull data from all Munson Medical Center databases, tabulate and analyze data without supervision.
Must possess strong oral and written communication skills. Must be able to educate, communicate and interact effectively and professionally with administrators, management, staff, and individuals outside the organization. Must maintain confidentiality.
Reports to the Reimbursement Director.
Works closely with Patient Financial Services, Medical Records, Information Systems, Utilization Management, Internal Audit and Compliance, and Patient Care departments when needed.
AGE OF PATIENTS SERVED
Cares for patients in the age category(s) checked below:
_ Neonatal (birth-1 mo) Young adult (18 yr-25 yrs)
Infant (1 mo-1 yr) Adult (26 yrs-54 yrs)
Early childhood (1 yr-5 yrs) _ Sr. Adult (55 yrs-64 yrs)
Late childhood (6 yrs-12 yrs) _ Geriatric (65 yrs & above)
Adolescence (13 yrs-17 yrs) _ All ages (birth & above)
X No direct clinical contact with patients
Supports the Mission, Vision and Values of Munson Healthcare
Embraces and supports the Performance Improvement philosophy of Munson Healthcare.
Promotes personal and patient safety.
Has basic understanding of Relationship-Based Care (RBC) principles, meets expectations outlined in Commitment To My Co-workers, and supports RBC unit action plans.
Uses effective customer service/interpersonal skills at all times.
Evaluates billing, coverage and reimbursement changes for all payers and supports management and educates staff in the development of new policies and procedures affected by these changes.
Coordinator of Munson Healthcare insurance rejections, denials and appeals. Produces monthly reports for Patient Financial Services management and various service line management within Huron software. Conducts monthly Revenue Cycle rejection and denials improvement meetings.
Provides education to individual service line management and staff regarding reimbursement, denials and appeals.
Works with and supports Patient Financial Services Management and staff on a day-to-day basis with creating policies and procedures, financial reporting and analysis, and payer reviews of reimbursement, denials and appeals.
Represents reimbursement concerns on the hospital STAR Coordinator financial implementation team.
Analyzes and produces routine reimbursement, rejection and denial reports which may entail obtaining and summarizing data from various sources..
Performs third party payer appeals based on knowledge of third party payer rules and regulations and Munson Healthcare operation procedures and patient care values.
Supports Management and staff in the review, development and implementation of insurance contract terms.
Identifies reimbursement variances and patterns and works with third party payers, contract managers and Munson staff to resolve the variances.
Provides billing and reimbursement information and reviews for various Patient Care departmental managers upon request.
Performs other duties and responsibilities as assigned
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