Appeals Analyst- Professional Billing (Business Data Analyst 1)
Oregon Health and Science University
Application
Details
Posted: 26-Mar-22
Location: Portland | US, Oregon
Type: Full-time
Salary: Open
Internal Number: 2021-13511
This position has the ability to work from home with the advantage of a flexible schedule. This position is primarily responsible for monitoring Professional Billing contractual allowances, analyzing and pursuing appeal opportunities with providers and networks, and reporting appeals performance.
Create advanced reports, Specialty reporting as needed, to identify carrier low payment trends and implement recovery strategies to recoup underpayments
Develop and implement process for identifying disallowed claims using contract management software and other tools as needed
Verify applicable contract as dictated by operational procedures. Review EOB messages; verify member information for managed care plans
Compile and submit appeals. Monitor process for proper reimbursement. Use contract management software to track appeals and recoveries
Establish and maintain helpful, productive and professional contacts with networks and providers
Collaborates with department staff on contracts, billing, registration, and errors
Participates in meetings to discuss ongoing trends and issues regarding the administration of managed care contracts
Promote and implement LEAN processes and Other duties as assigned
Bachelors degree in a business field and 6 months of experience that included analytical, database, spreadsheet and/or financial experience, technical writing, quantitative analysis or use of statistical principles; OR
Associates degree in a business field plus two years of experience that included analytical, database, spreadsheet and/or financial experience, technical writing, quantitative analysis or use of statistical principles; OR
Four years of experience that included analytical, database, spreadsheet and/or financial experience, technical writing, quantitative analysis or use of statistical principles OR
An equivalent combination of education, training and/or experience working with managed care claims and appeals for health care professional services that included experience with billing and collections, and/or other experience in a health care environment, including knowledge of HIPAA regulations, diagnosis and procedural codes and insurance claim processing.
Must be able to perform the essential functions of the position with or without accommodation.
Knowledge of provider network and contract language as well as compliance
Demonstrated analytical and research abilities for accurately reporting claims information
Knowledge of Health Information Systems
Exceptional interpersonal, customer relations and communication skills both written and verbal
Must be able to work with a diverse team and customer base
Proficiency with standard office equipment and software such as MS Office. Intermediate Microsoft Excel knowledge
Oregon Health & Science University values a diverse and culturally competent workforce. We are proud of our commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation contact the Affirmative Action and Equal Opportunity Department at 503-494-5148 or aaeo@ohsu.edu.
As an organization devoted to the health and well-being of people in Oregon and beyond, OHSU requires its employees to be fully vaccinated against COVID-19.
Bachelors degree in a business field and 6 months of experience that included analytical, database, spreadsheet and/or financial experience, technical writing, quantitative analysis or use of statistical principles; OR
Associates degree in a business field plus two years of experience that included analytical, database, spreadsheet and/or financial experience, technical writing, quantitative analysis or use of statistical principles; OR
Four years of experience that included analytical, database, spreadsheet and/or financial experience, technical writing, quantitative analysis or use of statistical principlesOR
An equivalent combination of education, training and/or experience working with managed care claims and appeals for health care professional services that included experience with billing and collections, and/or other experience in a health care environment, including knowledge of HIPAA regulations, diagnosis and procedural codes and insurance claim processing.
Must be able to perform the essential functions of the position with or without accommodation.
As the state's only health and research university, OHSU brings together patient care, research, education of the next generation of health care providers and scientists and community service to improve the health and well-being of all Oregonians.The university is a conduit for learning for more than 2,800 students, providing training to interns, residents and fellows in postgraduate medical and research. It is the only place in Oregon that grants doctoral degrees in medicine, dentistry and nursing. OHSU cares for more than 251,000 patients each year from around the region and takes a leadership role in contributing to solutions involving the health of the state and the nation, such as health care access and transparency, ethics and workforce shortage. Beyond providing critical health care services, quality education and cutting-edge research, OHSU also is a key economic and social force in the Northwest. With an annual operating budget of $2.06 billion and more than 14,000 employees, OHSU is Portland?s largest employer. Its size contributes to its ability to provide... many services and community support activities not found anywhere else in Oregon. For more information visit http://www.ohsu.edu/xd/about/index.cfm
