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Revenue Cycle Analyst, managed Care

Company: Mercy Health System
Location: Janesville
Posted on: August 5, 2022

Job Description:

Department/Skill highlights Revenue Cycle Reimbursement Analyst, Days, 80 hrs / 2 wks Location: Rockton Ave, Rockford IL. OR MercyCare Building, Janesville, WI. Hybrid work from home and flexible work schedule opportunities available after probationary period Experience a rewarding and fulfilling career with Mercyhealth. Mercyhealth is committed to offering our partners a best place to work. Our unique workplace Culture of Excellence is built upon: Employee engagement, empowerment and growth Teamwork toward our common goal # providing exceptional health care services with a passion for making lives better An atmosphere of caring and quality that cascades throughout the organization Essential duties and Responsibilities Interpret and understand coverage and benefit limitations by having a comprehensive understanding of benefits and state requirements for multiple markets. Identify trends and suggest and develop efficiencies in the revenue cycle through review and trending of payer contracts and reimbursement trends.# Research and trends denials from payors. Reads through healthcare contracts and contract language and ensures proper contract workflows. Researches remittances and Explanation of Benefits (EOBs) for complete accurate payments or denials. Work with payers to understand specific reasons for variances and/or denials and measures to prevent future denials. Research payer policies and requirements and utilize knowledge to determine whether an appeal is required and to get claims overturned. Develop sound and well-supported appeal arguments, where an appeal is warranted. Submits corrected claims and appeals. Coordinates appeals with clinical or coding areas within the revenue cycle. Requests appropriate adjustments, when required. Provide training and guidance to team members on market specific issues by providing feedback to management on claims and provider issues, and updating client business rules. Partner with Reimbursements team to assist in completing all other tasks as necessary to ensure accurate and timely internal turnaround times. Education and Experience Associate#s degree in finance, business, or healthcare administration and 3 years# experience working in revenue cycle, denials management and contract management required. 5 years of experience in lieu of degree. Special Physical Demands The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations. While performing the duties of this job, the employee is frequently required to sit; use hands to handle, finger, feel; reach, talk and hear. The employee is occasionally required to stand and walk. This is light work exerting up to 25 pounds of force occasionally. Specific vision abilities required by this job include constant close vision. Frequent ability to adjust focus. Prolonged sitting. Manual dexterity needed to operate telephone and keyboard. ################ ##############################

Department/Skill highlights

* Revenue Cycle Reimbursement Analyst, Days, 80 hrs / 2 wks
* Location: Rockton Ave, Rockford IL. OR MercyCare Building, Janesville, WI.
* Hybrid work from home and flexible work schedule opportunities available after probationary period

Experience a rewarding and fulfilling career with Mercyhealth. Mercyhealth is committed to offering our partners a best place to work. Our unique workplace Culture of Excellence is built upon:

* Employee engagement, empowerment and growth
* Teamwork toward our common goal - providing exceptional health care services with a passion for making lives better
* An atmosphere of caring and quality that cascades throughout the organization

Essential duties and Responsibilities

* Interpret and understand coverage and benefit limitations by having a comprehensive understanding of benefits and state requirements for multiple markets.
* Identify trends and suggest and develop efficiencies in the revenue cycle through review and trending of payer contracts and reimbursement trends.
* Research and trends denials from payors.
* Reads through healthcare contracts and contract language and ensures proper contract workflows.
* Researches remittances and Explanation of Benefits (EOBs) for complete accurate payments or denials.
* Work with payers to understand specific reasons for variances and/or denials and measures to prevent future denials.
* Research payer policies and requirements and utilize knowledge to determine whether an appeal is required and to get claims overturned.
* Develop sound and well-supported appeal arguments, where an appeal is warranted.
* Submits corrected claims and appeals.
* Coordinates appeals with clinical or coding areas within the revenue cycle.
* Requests appropriate adjustments, when required.
* Provide training and guidance to team members on market specific issues by providing feedback to management on claims and provider issues, and updating client business rules.
* Partner with Reimbursements team to assist in completing all other tasks as necessary to ensure accurate and timely internal turnaround times.

Education and Experience

* Associate's degree in finance, business, or healthcare administration and 3 years' experience working in revenue cycle, denials management and contract management required. 5 years of experience in lieu of degree.

Special Physical Demands

The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.

While performing the duties of this job, the employee is frequently required to sit; use hands to handle, finger, feel; reach, talk and hear. The employee is occasionally required to stand and walk. This is light work exerting up to 25 pounds of force occasionally. Specific vision abilities required by this job include constant close vision. Frequent ability to adjust focus. Prolonged sitting. Manual dexterity needed to operate telephone and keyboard.

Keywords: Mercy Health System, Janesville , Revenue Cycle Analyst, managed Care, Professions , Janesville, Wisconsin

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