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Job Summary:

The Claims Reimbursement Analyst is primarily responsible for thorough review of managed care contracts and comparison of these contracts against healthcare claims to identify underpayments. The incumbent in this position will work with the payor to resolve underpayments and will ensure receipt of any additional monies owed. They will provide feedback to other MWHC departments regarding any identified opportunities for process improvements to maximize reimbursement. The incumbent in this position will support the mission, vision, values, and strategic initiatives of Mary Washington Healthcare and must demonstrate a commitment of quality service to patients, physicians, the public, and co-workers.

Essential Functions & Responsibilities:

• Reviews insurance contracts to gain thorough understanding of payment methodologies.
• Analyzes claims and calculates reimbursements based on contract terms to determine accuracy of payment through use of various systems, reports, and supporting documentation.
• Contacts insurance companies to obtain missing information, explain and resolve underpayments, and arrange for payment or adjustment processing. Researches and compares third party refund requests to the contract to determine appropriateness.
• Submits and/or documents refund information in the financial system for all appropriate accounts.
• Documents and communicates trends to the Manager and makes recommendations of possible solutions.
• Prepares and submits correspondence such as letters, emails, faxes, online inquiries, appeals, adjustments, reports, and payment posting.
• Maintains regular contact with necessary parties regarding claims status including payors, managers, and other MWHC Revenue Cycle personnel.
• Provides feedback as necessary to other MWHC departments to ensure process improvement and training/education occurs in a timely manner.
• Supports and directs claims to all MWHC departments, as applicable.
• Build strong, lasting relationships with payors.
• Complies with Federal, State and local legal requirements and maintains operations by adhering to requirements, following policies, procedures, rules and regulations. Performs other duties as assigned.

Qualifications:

• Minimum of 2 years experience working in an operational setting, preferably managed care or hospital patient accounts required; 4 years experience in managed care and/or hospital patient account receivable collections and payment variance monitoring for payors preferred.
• Certified Revenue Cycle Specialist (CRCS) certification or related certification required or eligible to obtain within 1 year of hire.
• High School diploma or equivalent required.
• Experience with MS Excel, Word, and Outlook. Experience working with ICD-10, CPT-4 and/or HCPCS coding systems.
• Knowledge of insurance submittal procedures and medial forms (including UB04 and CMS1500).
• Experience with reading and interpreting an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written and diagram form.

As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.