What are the responsibilities and job description for the Health Care Reimbursement Analyst II - Labs/Pathology Services position at uic?
Description:
Provides expertise on Medicare and Medicaid government regulations to complete statistical and financial modeling and producing cost reports to ensure all possible reimbursement enhancements or opportunities are captured. Assists in the design and development of strategic initiatives through data gathering, data analysis, and performance improvement planning. Assists in gathering data for analysis and reports for both intradepartmental and interdepartmental needs. Works with finance to maximize reimbursement from third party payors.
Duties & Responsibilities:
- Uses knowledge of Medicare and Medicaid government regulations to complete statistical and financial modeling and producing cost reports to ensure all possible reimbursement enhancements or opportunities are captured for the Pathology technical and professional billing for Inpatients, Outpatients, and Outreach Clients..
- Completes an analysis of new developments and/or proposals in the reimbursement field to determine the financial impact on the healthcare facility.
- Analyzes and advises facility administration via impact analysis of new regulatory changes and how they will affect the funding of the Pathology/Laboratory Medicine services and reimbursement
- Gathers data and completes required analysis at the request of outside audit staff during audits by Medicare, Medicare, and Blue Cross and reports the impact of audit adjustments to management
- Assists management in the analysis and development of third-party contractual allowances using financial and statistical modeling.
- Assists in determining the cost-analysis of new patient testing, comparing both performance of testing inhouse and as a reference test
- Assists in reducing Epic Work queues and developing algorithms or rules to eliminate the confounding barriers to charges
- Assists management in the analysis and development of bad debt projections using financial modeling for budget forecasting.
- Assists in Charge Description Master (CDM) requests for new/revised patient testing.
- Assists more senior staff members in the review of existing operating procedures and makes recommendations for the development of settlement data to maximize reimbursement from third party payors.
- Recommends improvements and modifications to departmental operating procedures to maximize operation efficiency and reimbursement
- Completes review and analysis of prior years’ outstanding cost reports to resolve outstanding issues in conformance with regulations and within the time frame imposed by the federal government’s statute of limitations
- Reviews current and prior years’ data and other necessary variance explanation in coordinating the annual financial audit of the healthcare facility by outside audit firms
- Perform other related duties and participate in special projects as assigned.
