To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
The Patient Account Analyst is responsible for retrospective audits of third party payer payments to determine if correct contract reimbursement methodology was used. Patient Account Analysts are also responsible for determining if additional reimbursement is due and uses an optimal combination of rebilling, collections and required payment follow up activities to resolve outstanding balances of disputed contract accounts. Identifies, organizes and presents issues created by Managed Care contracts, complex billing regulations and other specific payment requirements and works directly with the Patient Account Specialist, the Senior Patient Account Specialist, Manager, Patient Account Analysis and the Third Party Payers as necessary to determine possible solutions. Serves as primary feedback mechanism to determine if contract specifications are being adhered to retrospectively. Provides QA feedback accounts reviewed as required by department goals.
Responsibilities: 1. Retrospectively analyzes accounts with payment variances or denials to ensure proper contractual payments amounts and accurate SDK prorations in an effort to achieve department recovery goals. 1.1. Identify trends/payer issues via payment variance function or denial review, documents and summarizes findings. 1.2. Uses established rebilling, collection and follow up procedures to effectively expedite the prompt resolution of outstanding claims within the realm of denials, disputed contract reimbursement, retrospective underpayments and identified specialty reimbursement issues. 2. Develop professional working relationships with payer representatives and other SBO staff members in order to understand and resolve payer issues. 2.1. Coordinate with specialists to ensure effective communication with third party representatives. 2.2. Achieve a partnership with the appropriate level staff member of the corresponding follow up team. 2.3. Provides updates to Patient Account Specialist, Manager, Patient Account Analysis, and/or Senior Manager, Patient Account Analysis, regarding project assignments. 3. Demonstrates sound knowledge of various systems used to perform daily functions. Makes timely decisions with regard to maintaining department documentation for procedure compliance. 3.1. Effectively uses SDK and/or other the computer systems and daily reports to access and review daily work file to identify accounts requiring retrospective activity. 3.2. Reviews open requests or issues with payer and takes corrective action. 4. Completes various data collection and reporting task to support the department functions as well as reporting on the various department goals. 4.1. With some assistance, assumes report writing responsibilities necessary to complete daily work, weekly/monthly reporting and on going monitoring of the departmental Accounts Receivables using a variety of systems. 4.2. In conjunction with the Patient Account Specialists and Manager, Patient Account Analysis, prepares monthly and / or quarterly reports of findings and accounts receivable to be used and distributed to SBO management and may be used for the purpose of updating policy and procedures. 5. Complies with all department procedures to ensure retrospective reviews are completed and in a timely fashion. 5.1. Initiates effective follow up for contract issues via telephone contacts, written correspondence or site visits with appropriate parties. 5.2. Documents all activity regarding accounts, contracts or denials in a clear and concise manner to aid in the resolution of issues of current operations. Organizes and presents findings to payers and internal SBO management as required. 5.3. Identifies and reports on problem areas and trends by third party payer contracts. Participates in the denial and appeals process with some assistance from Specialists. 5.4. Uses proper escalation procedures both internally and externally after exhausting all avenues for timely resolution of identified contract issues. 6. Performs quality assurance audits and prepares appropriate files to be used for feedback as defined by department goals. 6.1. Maintains level of quality of work as illustrated in current department goals 6.2. Completes all necessary internal control documents/task in accordance to documented time frames. 7. Performs all other duties as requested by the manager to maintain a smooth operation of the Patient Account Analysis department and contributes to group and departmental goals.
Bachelors degree with major course work in Business Administration, Finance and/or Accounting or equivalent work experience in an Accounts Receivable environment.
A minimum of three (3) years of billing, claims management or contract compliance experience in a hospital/healthcare computerized accounts receivable environment. Experience must include use of PCs.
Strong professional communication, organizational and time management skills. Must be proficient with software packages including spreadsheets, word processing and data base management. Extensive knowledge of third party insurance carriers and their billing and reimbursement requirements. Demonstrated ability to interpret third party contracts from an operational perspective. Excellent analytical and mathematical skills with a high degree of accuracy required. Ability to perform detailed analysis quickly and accurately.
Responsible for the retrospective audit of paid claims, and concurrent work and review of claims in a contract dispute. Must develop and maintain effective relationships with provider representatives and other internal and external professionals to ensure accurate reimbursement according to a variety of contracts.
Highly organized individual with the ability to analyze data, problems, and exercise sound independent judgement. Exercises sound and independent problem solving skills. Capable of using analytical skills and resourcefulness to accomplish many tasks and balances multiple priorities in a tense, highly active environment. Ability to deal professionally (through written or verbal communication) with other departments, third party payers, and other agencies to resolve complex issues related to maximizing reimbursement.