Reimbursement Analyst

  • Location Jacksonville, Florida
  • Type Contract
  • Job ID Job #55069

The CSI Companies is actively seeking a Reimbursement Analyst for a well-known healthcare provider, one of the Southeast most comprehensive academic health center in the Jacksonville, FL area. 

Schedule: Monday through Friday, 8am-5pm  

Pay: Based on experience


Job Description

  • Applies strong analytical skills to compile and analyze data estimating the impact of various reimbursement issues – to include standard, periodic and on-demand reports. Serves as a reimbursement information source for providers and staff. Provides manager with data to ensure that the fees established will enable the company to obtain maximum reimbursement and cover costs for providing the product or service. Communicate with Business Group Managers and providers to ensure appropriate application of CPT and ICD-10 coding changes that affect the various groups. 
  • Has a primary role in the development, analysis, and production of budgeted collection rates for specified carriers. Examines the budget estimates for completeness, accuracy and conformance with established coding procedures, guidelines and organizational considerations. Reviews past and current budgets and research industry developments that affect the organization's application of codes. Completes tasks under extreme pressures of deadlines and tight work schedules during the budgeting period
  • Responsible for creation and maintenance of charge capture forms for departments that need the additional layer of support. 
  • Responsible for auditing various functions and products (i.e. Epicare templates used by clinics and physicians, electronic Medicare charts for GPRO, Research Guarantor Accounts) to ensure correct billing and documentation standards are being met)
  • Assists Director of Clinical Data Quality and Manager of Reimbursement and Quality Improvement with special projects as assigned. 

Essential Functions

  • Compile data for annual and periodic fee schedule analysis
  • Compile daily and monthly reports that affect multiple departments or areas related to reimbursement issues
  • Update and maintain provider fees/fee schedules in computer system (Excel and IDX)
  • Prepare, publish, and distribute fee schedules (paper)
  • Daily review of the missing fee WQ in Epic. Work with the business groups to reolve any missing fees or billing errors in the WQ resulting in a blank or zero fee in the amount field. 
  • Develop, maintain and update Excel spreadsheets with commercial and government carrier allowable information. Format data into flat files for import into the Epic system
  • Perform research and analysis of managed care contracts as directed by Director of Clinical Data Quality
  • Perform annual impact analysis of Medicare and Medicaid annual rate changes
  • Perform annual impact analysis of fee schedule changes
  • Compile department, division, billing area, and location specific analyses of charges and payments by carrier to assist accounting with determining reasonable collection rates as necessary for the budget process
  • Review annual additions, deletions and updates on procedure and diagnosis codes and coordinate with IS to update respective edits and dictionaries as needed. Communicate potential impact of major changes to Business Group Managers to incorporate needed adjustments in annual budget calculations
  • Develop, maintain and update charge capture forms (including superbills) as needed. Review EpiCare templates used by clinics and physicians for accuracy and coding changes
  • Assist providers, clinic personnel and billing staff with reimbursement information and carrier specific billing guidelines
  • Remain current on all coding and reimbursement issues
  • Assist education department with research and analysis for coding related projects
  • Assist special projects department with managed care related inquiries and projects as necessary
  • Assist with compiling initial book order for CPT, HCPCS, ICD-10 and specialty books. Prepare Excel spreadsheets to be used for purchase order requests, receiving signatures and accounting reconciliation. Facilitate delivery/pick-up of books from within the Reimbursement department after books are delivered, inventoried and reconciled to the original order
  • Abstract data from EHR for annual Medicare GPRO measures. Prepare data for upload into the CMS web-interface system
  • Conduct periodic GPRO measure audits throughout the year to ensure compliance with documenting quality meansures. Provide feedback to physicians and clinics with results and areas for improvement
  • Analyze results from GPRO submission and provide summary feedback to departments for quality improvement opportunities
  • Assist Manager of Reimbursement and Quality Improvement and Director of Clinical Data Quality with research and analysis for special reimbursement projects. 
  • Review research study initiation request forms (RSIRF's) for proper coding and pricing. Communicate with research coordinator or other appropriate individuals to resolve conflicts in the information prior to submitting RSIRF to Manager of Reimbursement and Quality Improvement for final signature
  • Conduct weekly audits on Research Guarantor records in Epic to ensure registration errors have not corrupted the accuracy of the data. Make corrections and provide feedback as needed. 
  • Conduct weekly audits on personal/family accounts to ensure research coverage has not been incorrectly assigned. Measure corrections and move transactions as appropriate
  • Monitor accounts for patients being associated to a research study but no research coverage added to the guarantor accounts. Make corrections and provide feedback as appropriate.

 Position Requirements:

  • 3-5 years medical billing/claims experience including coding, medical terminology and third party reimbursement
  • Microsoft Office proficiency is required – must be expert in Excel
  • High School diploma/GED required; Associate's Degree preferred
  • CPC or other coding credential preferred