Reimbursement Analyst

Job Summary Gathers and analyzes financial information in accordance with the provider's negotiated contract to determine correct configuration of the claims payment system(s). Knowledge of facility and physician reimbursement methods will be combined with data analysis and business decision-making abilities to determine correct configuration. Analyst will take the lead, and serve as a liaison on problem resolution for internal and external customers. Essential Functions Highly skilled in provider and pricing set-up. Articulates Priority Health's payment models and standard reimbursement methods for all providers and products. Research issues related to problems arising from provider or pricing set up and/or procedures. Determine root cause and take necessary action to resolve. Ensure effective communication of resolution to appropriate leadership. Facilitate the timely and accurate contract implementation by completing necessary paperwork for new fee schedules, PFP groups, risk pools, PHO extensions, etc., as well as working with operational areas for non-standard contractual commitments. Ensure necessary approvals are documented to facilitate execution of standard and non-standard contract templates. Develop Priority Health's fee schedule models and standards. Research issues related to problems arising from fee schedule set up and/or procedures. Determine root cause and take necessary action to resolve. Ensure effective communication of resolution to appropriate leadership. Apply strong analytical skills and business knowledge to the investigation, analysis and recommendation of creative solutions to problems. Communicates, collaborates and acts as a consultant to internal and external customers in order to resolve medium level complexity provider issues. Performs routine audits to identify trends and factors contributing to performance of contracts. Maintain process related documentation as necessary to support results of audit, with effective communication and information exchange with internal and external customers. Monitors, develops, and improves job procedures to ensure maximum effectiveness in process and resource time spent on job tasks. Monitor government program websites for timely updates as it relates to medical billing changes, pricing changes which may include ensuring fees are loaded into appropriate fee schedules according to established procedures, etc. Qualifications Required Associate's Degree Emphasis in health care, business management (or equivalent combination of education and experience). 3 years of relevant experience Knowledge of FACETS and OnBase Required 3 years of relevant experience Knowledge of provider reimbursement methods and concepts (Medicare, Medicaid, Commercial) and industry standard pricing guidelines Required 1 year of relevant experience Knowledge of UB92 or 1500 billing Preferred 3 years of relevant experience Experience in Microsoft applications including Word, PowerPoint, Excel Required Physical Demands Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs Waist to Waist > 5 lbs: Seldom up to 10 lbs Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs Waist to Overhead > 5 lbs: Seldom up to 10 lbs Bilateral Carry > 5 lbs: Seldom up to 10 lbs Unilateral Carry > 5 lbs: Seldom up to 10 lbs Pushing Force > 5 lbs: Seldom up to 10 lbs Pulling Force > 5 lbs: Seldom up to 10 lbs Sitting: Frequently Standing: Occasionally Walking: Occasionally Forward Bend - Standing: Seldom Forward Bend - Sitting: Occasionally Trunk Rotation - Standing: Seldom Trunk Rotation - Sitting: Occasionally Stair Climbing: Seldom Reach - Above Shoulder: Seldom Reach - at Shoulder or Below: Seldom Handling: Occasionally Forceful Grip > 5 lbs: Seldom Forceful Pinch > 2 lbs: Seldom Finger/Hand Dexterity: Frequently Primary Location SITE - Priority Health - 1239 E Beltline - Grand Rapids Department Name PH - Provider Reimbursement Employment Type Full time Shift Day (United States of America) Weekly Scheduled Hours 40 Hours of Work 8 - 5 Days Worked Monday - Friday Weekend Frequency N/A CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only. Corewell Health is committed to providing a safe environment for our team members, patients, visitors and community. That is why we require a drug-free workplace and various vaccinations as a requirement for employment. Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category. An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team. If you are a qualified individual with a disability, you may request assistance in completing the application process by calling 616.486.7447. We are committed to granting reasonable accommodations in accordance with applicable laws. People are at the heart of everything we do, and the inspiration for our legacy of outstanding outcomes, innovation, strong community partnerships, philanthropy and transparency. Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team of 60,000 dedicated people—including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing care and services in 22 hospitals, 300 outpatient locations and several post-acute facilities—and Priority Health, a provider-sponsored health plan serving more than 1.2 million members. Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness.