What are the responsibilities and job description for the Reimbursement Analyst position at Spectrum Health?
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.
How Corewell Health cares for you
Comprehensive benefits package to meet your financial, health, and work / life balance goals. Learn more .
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
Optional identity theft protection, home and auto insurance, pet insurance
Traditional and Roth retirement options with service contribution and match savings
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
3 years of relevant experience Knowledge of provider reimbursement methods and concepts (Medicare, Medicaid, Commercial) and industry standard pricing guidelines
3 years of relevant experience Experience in Microsoft applications including Word, PowerPoint, Excel
About Corewell Health
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
Comprehensive benefits package to meet your financial, health, and work / life balance goals. Learn more .
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
Optional identity theft protection, home and auto insurance, pet insurance
Traditional and Roth retirement options with service contribution and match savings
Eligibility for benefits is determined by employment type and status
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
Hours of Work
8 to 5
Days Worked
Monday to 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. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
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.
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