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Payer Performance Analyst Lead

Rapid City-SD

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Current Employees:

If you are a current employee, please apply via the internal career site by logging into your Workday Account and clicking the "Career" icon on your homepage.

Job Category

Revenue Cycle

Department

CS Managed Care

Scheduled Weekly Hours

40

Shift

Employee Type

Regular

Job Summary

Provides analytical and technical support to the Revenue Cycle team in the planning, implementation, coordination and ongoing system maintenance of the denial, underpayment and contract modeling system, currently Payment Integrity Compass (PIC).
Maximizes the Health System's revenue recovery efforts through effective coordination of the usage of Payment Integrity Compass by various Revenue Cycle staff.

Job Description

Essential Functions:

  • Thoroughly understands the wide variety of reimbursement methodologies used through the Healthcare receivables industry.
  • Functions as a super user for implementation and maintenance of computerized denial, underpayment contact modeling system.
  • Responsibilities include verification and accuracy of data, compiling data and ability to translate information into multiple formats (Excel, Access, PowerPoint and white paper format).
  • Provides monthly reporting that assists in identifying root causes of denials, underpayments, payer response and resolution to existing and prospective AR. •Responsible for coordinating work efforts needed to identify trends in underpayments, denials, revenue opportunities and revenue leakage.
  • Works closely with each department responsible for root causes to trend issues and provides feedback that will result in reduced preventable denials and underpayments. Works collaboratively with respective departments to evaluate trends and be part of the team that works towards resolution.
  • Works in collaboration with Managed Care Manager to obtain current Payer fee schedules and ensure accurate and timely loading, auditing, and validating of contract information.
  • Creates and reviews operational reports for identification of improvement opportunities and makes recommendations to re-engineer processes.
  • Participates in Managed Care, Value Based Incentive Program Committee meetings and provides reports and analytics for presentations as needed.
  • All other duties as assigned.

Additional Requirements

Preferred:
Experience - 1+ years of Hospital Experience; 3+ years of Revenue Cycle Experience
Education - Bachelors degree in Healthcare Administration or Related Field

Physical Requirements:
Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

15 Corporate Services Division

Make a differenceEvery day.

Monument Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.

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Chat Schedule ( Mountain Time )

Today, Oct 23, 10:00AM-3:00PM

Show more
Chat Offline

Chat Schedule ( Mountain Time )

Today, Oct 23, 10:00AM-3:00PM

Show more
Chat Offline