Contract Reimbursement Analyst

Mauston, WI - USA

Monthly Salary: Not Disclosed

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

General Information:

Job title: Contract Reimbursement Analyst

Schedule: Full-time 80 hours per pay period; Monday Friday 8-5

Position Summary:

The Contract Reimbursement Analyst is responsible for analyzing modeling and monitoring payer reimbursement to ensure accurate payment in accordance with contract terms. This role interprets complex reimbursement methodologies evaluates contract performance and identifies payment variances that impact net patient revenue. The analyst collaborates with revenue cycle finance and clinical areas to support contract negotiations resolve underpayment issues and improve reimbursement outcomes. Through data analysis reporting and system validation the position helps safeguard revenue integrity and provides leadership with insights into payer performance and financial risk.

Position Responsibilities:

Review and interpret managed care contracts (commercial Medicare Advantage Medicaid MCOs). Translate contract terms into payment methodologies identify carve-outs stop-loss provisions outlier terms and reimbursement exceptions. Prepare and maintain contract summaries and reimbursement matrices for internal use.
Build models to calculate expected reimbursement based on contract terms analyze financial impact of new or renegotiated payer contracts support contract negotiations with reimbursement projections and scenario modeling assist evaluations on how coding case mix or volume changes affect reimbursement.
Compare expected vs. actual payments at the claim level identify underpayments overpayments and systemic payer issues and research root causes (incorrect DRG fee schedule errors bundling logic modifier reductions). Quantify revenue impact and support recovery/escalation efforts
Develop recurring and ad hoc reports on payer reimbursement performance net revenue by payer/product line variance trends and recovery results track contract compliance and identify unfavorable payment patterns and present findings to CFO.
Work closely with revenue cycle and billing department coding and clinical documentation teams quality and UR finance and decision support and provide any necessary education on payer reimbursement rules and contract requirements.
Assist with payer disputes and escalated payment issues.
Assist with building and maintaining contract logic in contract management system perform ongoing validation of reimbursement accuracy test payment outcomes after fee schedule changes or contract renewals.
Monitor Medicare and Medicaid payment updates that affect hospital reimbursement track payer policy changes that may affect contract payments and update internal reimbursement assumptions and models accordingly.
Ensure contract terms are applied accurately and consistently identify potential compliance risks related to billing and reimbursement and support audit requests and documentation of reimbursement methodologies.
Maintain and update the Chargemaster (Charge Description Master) File in the Meditech Expanse system.
Ensure CDM entries align with CPT/HCPCS coding guidelines Medicare OPPS and NCCI edits CMS billing rules and status indicators and supports compliance with payer billing requirements.
Assist with CDM pricing reviews and annual price updates work with CFO to evaluate pricing impact on reimbursement and cost reports.
Perform other duties as requested.

Position Requirements:

High school diploma or equivalent required.
1 years of related work experience preferred.
Exceptional accuracy and attention to detail required.

Knowledge Skills & Abilities:

Intermediate proficiency with computers is required.
Ability to understand and calculate multiple reimbursement models to compare and contrast during contract negotiations.
Knowledge of contract language and negotiation.
Knowledge of the insurance industry.
Strong quantitative and analytical competency.
Self-starter with excellent interpersonal communication and problem-solving skills.

Required Experience:

General Information:Job title: Contract Reimbursement AnalystSchedule: Full-time 80 hours per pay period; Monday Friday 8-5Position Summary:The Contract Reimbursement Analyst is responsible for analyzing modeling and monitoring payer reimbursement to ensure accurate payment in accordance with contr...

General Information:

Job title: Contract Reimbursement Analyst

Schedule: Full-time 80 hours per pay period; Monday Friday 8-5

Position Summary:

Position Responsibilities:

Review and interpret managed care contracts (commercial Medicare Advantage Medicaid MCOs). Translate contract terms into payment methodologies identify carve-outs stop-loss provisions outlier terms and reimbursement exceptions. Prepare and maintain contract summaries and reimbursement matrices for internal use.
Build models to calculate expected reimbursement based on contract terms analyze financial impact of new or renegotiated payer contracts support contract negotiations with reimbursement projections and scenario modeling assist evaluations on how coding case mix or volume changes affect reimbursement.
Compare expected vs. actual payments at the claim level identify underpayments overpayments and systemic payer issues and research root causes (incorrect DRG fee schedule errors bundling logic modifier reductions). Quantify revenue impact and support recovery/escalation efforts
Develop recurring and ad hoc reports on payer reimbursement performance net revenue by payer/product line variance trends and recovery results track contract compliance and identify unfavorable payment patterns and present findings to CFO.
Work closely with revenue cycle and billing department coding and clinical documentation teams quality and UR finance and decision support and provide any necessary education on payer reimbursement rules and contract requirements.
Assist with payer disputes and escalated payment issues.
Assist with building and maintaining contract logic in contract management system perform ongoing validation of reimbursement accuracy test payment outcomes after fee schedule changes or contract renewals.
Monitor Medicare and Medicaid payment updates that affect hospital reimbursement track payer policy changes that may affect contract payments and update internal reimbursement assumptions and models accordingly.
Ensure contract terms are applied accurately and consistently identify potential compliance risks related to billing and reimbursement and support audit requests and documentation of reimbursement methodologies.
Maintain and update the Chargemaster (Charge Description Master) File in the Meditech Expanse system.
Ensure CDM entries align with CPT/HCPCS coding guidelines Medicare OPPS and NCCI edits CMS billing rules and status indicators and supports compliance with payer billing requirements.
Assist with CDM pricing reviews and annual price updates work with CFO to evaluate pricing impact on reimbursement and cost reports.
Perform other duties as requested.

Position Requirements:

High school diploma or equivalent required.
1 years of related work experience preferred.
Exceptional accuracy and attention to detail required.

Knowledge Skills & Abilities:

Intermediate proficiency with computers is required.
Ability to understand and calculate multiple reimbursement models to compare and contrast during contract negotiations.
Knowledge of contract language and negotiation.
Knowledge of the insurance industry.
Strong quantitative and analytical competency.
Self-starter with excellent interpersonal communication and problem-solving skills.

Required Experience:

Key Skills

IVR
SOAP
Avaya
Solaris
Cost Accounting Standards
Database Design
Hibernate
ITIL
Weblogic
Express.js
Contracts
ASP

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About Company

Mile Bluff Medical Center

Mile Bluff Medical Center is Juneau County's only full-service hospital serving the six-county region. We are committed to providing compassionate and progressive care.

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