RIQA Analyst

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New Haven, CT
Jan 25, 2021

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Job Description

Overview

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 Receivable Integrity Analyst reports to the Receivable Integrity QA Coordinator and ensures proper movement of accounts receivable through Revenue Cycle. Performs and follows up on special project rebilling. Validates and initiates remedial action on provider liable type denials. Facilitates rebilling/resubmissions requests associated with denied accounts. Follow up on aged appeals or high value appeals. Performs rebilling as part of the change visit type process. Documents all follow up activities on accounts in a clear and concise manner. Assists in various QA reviews as directed. Collects information related to Quality Assurance and/or Process Optimization.

EEO/AA/Disability/Veteran

Responsibilities

  • 1. Performs rebilling projects related to Special Projects and follows up on associated claims as needed to ensure proper resolution of accounts.
  • 2. Validates denial information relayed by the payer and takes appropriate remedial action to allow for most efficient resolution and records information accordingly.
  • 3. Performs follow up on account rebilled as part of Special Projects, aged, high value appeals or other select types of denied claims which may require follow-up.
  • 4. Documents all follow up activities, in addition to project tracking and denial monitoring data, on patient accounts in a clear, concise and accurate fashion.
  • 5. Assists Quality Assurance or Process Improvement initiatives through focused account review and collects pertinent information associated with the QA/Process Improvement under the guidance of QA Lead/Coordinator and/or Manager.
  • 6. Keeps abreast of changing federal, state, and insurance regulations and the guidelines within the various managed care contracts in a dynamic healthcare environment.
  • 7. Performs all other duties as requested by the Coordinator to maintain a smooth operation of the department and contributes to group goals. The employee must also project a positive image of the department and the hospital.

Qualifications

EDUCATION


High school graduate with business or accounting related courses. Enrolled or working toward Associate Degree preferred.


EXPERIENCE


One (1) to two (2) years billing or claims management experience in a hospital/healthcare computerized accounts receivable environment. Experience should include extensive use of PCs.


SPECIAL SKILLS


Extensive knowledge of all third party insurance carriers Including governmental payers and their billing and reimbursement requirements Excellent analytical and mathematical skills with a high degree of accuracy. Demonstrated ability to perform detailed analysis quickly and accurately. Need to have keyboard skills of at least 45 wpm and use a calculator. Ability to communicate effectively both written and verbally. PC skills including word processing, Excel, Microsoft Office, and other related software


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Job Info

Job: 24574

Department: Receivable Integrity
Category: FINANCE
Sub Category: GENERAL CLERICAL
Status: Full Time Benefits Eligible
Shift: DAYS
Hours: 40

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