Duration- 6 Months

Hybrid- Baton Rouge, LA

Pay- Market Rate

OVERVIEW :

• This position is responsible for providing entry level analytical support in the healthcare insurance reimbursement department that is responsible for managing hospital, physician and other healthcare provider contracts governing billing and payments.
• All levels of internal personnel, with primary contacts in Network Administration, Network Operations, IT, Medical Management, Benefits Administration and Medicare Advantage.

Providers, provider representatives, vendors and consultants to exchange or review program information. Other data sources are market research consultants, AMA, St. Anthony, HIAA,CMS,

REQUIRED SKILLS :

• Bachelor’s degree in statistics, accounting, finance, mathematics, health informatics or related field is required
• Strong EXCEL experience- Proficiency with Microsoft Excel including Pivot Tables and experience with either Microsoft Access or SQL Server for building queries and statistical reports required-Report Preparation
• Licenses and Certifications
• Four years of related experience can be used in lieu of a Bachelor’s degree.
• Six months of health care analysis, analytics, IT or management consulting experience .
• Professional level work experience in a provider office, health insurance reimbursement and / or financial analysis is preferred
• Experience with medical coding (ICD9, HCPCS, CPT4) is preferred
• Experience interpreting, explaining, summarizing and making recommendations based upon research and statistical analysis (e.

g. business case study recommendations, etc.) is preferred

RESPONSIBILITIES :

• Provides reimbursement assistance to Network Administration staff, Network Operations staff, Information Technology staff, Benefits Administration staff, Provider Audit staff by
• developing and implementing project / program narratives and responding to concerns on new and existing reimbursement programs, billing guidelines, and system requirements toensure accurate implementation and maintenance of provider reimbursement programs, under the direction of the departmental director and working closely with more senior levelreimbursement staff.

May serve on related committees.

• Identifies claims and provider reimbursement related system problems, including claims coding and processing issues, and coordinates research, audit, and recommendations withProvider Audit, and implements and monitors system changes to resolve these problems, under the direction of the departmental director.
• Researches, designs, implements, and maintains moderately complex hospital or professional provider reimbursement programs, under the direction of the departmental director, withincorporate objectives on project implementation and schedule deadlines.

Contacts other plans, consultants, and local providers to assist in program specifications.

• Analyzes and produces management reports to monitor effectives and identify and resolve deficiencies of reimbursement programs in comparison to industry benchmarks, competitors,and Medicare.
• Utilizes financial pricing models and financial data analysis under the director of the department director to support modifications to reimbursement programs and assist management inidentifying deficiencies and monitoring effectiveness.
• Provides statistical reports to Network Administration, Medical Management, Marketing and Medicare Advantage staff to support internal strategies and external customer needs, suchas contract negotiations and marketing efforts.
• Responds to ad hoc requests such as auditing of contracts, responses to RFI / RFPs, researching Medicare and other industry policies and reimbursement methodologies.

Compiles feedisclosure requests and pricing of daily claim inquiries from various sources.

Additional Accountabilities and Essential Functions

Job ID : JOB-235872

Publish Date : 12 Jun 2024

Tagged as : Healthcare Associate Reimbursement Data Analyst

Last updated : 2024-07-01