Tracking Code: 204277

Payer Reimbursement Analyst - Denials Prevention - Day

Location: WellSpan Health, York, PA
Schedule: Full Time

General Summary

Holds a pivotal position in ensuring hospitals receive accurate compensation for the services they provide by examining hospital claims to verify proper reimbursement and working with stakeholders to resolve issues and optimize reimbursement processes while adhering to regulatory guidelines and organizational policies.

Duties and Responsibilities

Remote Work Capable

Essential Functions:

  • Serves as a subject matter expert with assigned payors to address Payer Variances and Denials.
  • Investigates reasons for discrepancies, such as payment variances, coding errors, billing discrepancies, contract build or incorrect application of payer policies. Accesses external payer sites for payer policies, claim investigations, and claim disputes.
  • Utilizes best practices along with technology enabled worklist and other internal tools to identify discrepancies between expected reimbursement and actual reimbursement amounts from insurance carriers.
  • Provides trend analysis to management, leadership, and insurance liaison. Ensures timely recovery of underpayment and denials, while addressing any root causes that are contributing to incorrect payments.
  • Prepares and submits correspondence such as letters, emails, faxes, online inquiries, appeals, adjustments and reports.
  • Maintains thorough documentation, including root cause of underpayment or denial issues, trends, outcomes, and lessons learned to support ongoing improvement efforts and knowledge sharing within the organization.
  • Actively participates in discussions, meetings, and brainstorming sessions where team members contribute insights and suggestions for improving processes.
  • Provides input for contract renegotiations with the goal to streamline process, reduce variances and denials.
  • Maintains the payer reference guides for assigned payers with known nuances, best practice processes for authorizations and appeals, and any current trends.
  • Reviews dashboards and reports to monitor for root cause analysis, potential trends or patterns to reduce underpayments and denials.
  • Corrects financial and demographic information that has been inaccurately entered into Epic.
  • Assumes responsibility to lead projects as requested. May also lead process improvement initiatives for the department.
  • Assists Team Lead with onboarding and training new staff, as requested.

Common Expectations:

  • Maintains established policies and procedures, objectives, quality assessment and safety standards.
  • Enhances professional growth and development through participation in educational programs, current literature, in-service meetings, and workshops.
  • Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Qualifications

Minimum Education:

  • High School Diploma or GED Required
  • Bachelors Degree Preferred

Work Experience:

  • 5 years Revenue Cycle experience Required

Licenses:

  • Certified Revenue Cycle Specialist within 1 year Required or
  • Certified Revenue Cycle Professional within 1 year Required or
  • Certified Revenue Cycle Representative within 1 year Required or
  • Certified Patient Accounts Manager within 1 year Required or
  • Certified Healthcare Financial Professional within 1 year Required

Courses and Training:

  • Business/Accounting, Finance or Management. Upon Hire Preferred

Knowledge, Skills, and Abilities:

  • Excellent communication and interpersonal skills.
  • Familiarity with ICD-10 and CPT codes.
  • Strong knowledge of payer reimbursement rules, methodology and policies.
  • Proficiency in healthcare billing systems (Epic preferred).
  • Working knowledge of medical terms to help interpret edit resolution, claims remittance advice, medical record documentation and payer medical/payment policies.
  • Ability to work independently, multitask, and prioritize in fast paced environment.
  • Possess ability to work in a constantly changing environment, good judgment skills, and capable of making decisions with attention to detail.
  • Strong analytical and problem-solving skills.
  • Works effectively in a team environment.
  • Proficient with Excel and Microsoft office.

You’re unique and you belong here.

At WellSpan Health, we are committed to treating all applicants fairly and equitably, regardless of their job classification. If you require assistance or accommodation due to a disability, please reach out to us via email at employment@wellspan.org. We will evaluate requests for accommodation on a case-by-case basis. Please note that we will only respond to inquiries related to reasonable accommodation from this email address. Rest assured, all requests for assistance or accommodation are handled confidentially, allowing applicants to share their needs openly and honestly with us.

Renee Kegarise
Renee Kegarise
Sr. Talent Acquisition Consultant

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Employment Benefits

  • Sign-on incentives for new employees
  • Medical, dental and vision insurance
  • Life and accidental death insurance
  • Supplemental life insurance
  • Retirement savings plan
  • Paid time off (PTO)
  • PTO bridging
  • Short-term disability
  • Educational assistance
  • Forgivable loan
  • Flexible spending
  • Credit union
  • Employee recreational activities
  • Childcare
  • Complimentary medicine discounts
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Welcome. Respect. Value.

Diversity, Equity & Inclusion at WellSpan

WellSpan Health recognizes and honors the diversity of our team members, patients and neighbors, and we embrace all the human characteristics that make us similar and unique. We strive to make every person feel welcomed, respected and valued by creating a safe and inclusive environment to which we all feel a sense of belonging. We are equally committed to ensuring all team members have the opportunity to excel and are positioned for success through equitable policies, practices and resources.

WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability or any other legally protected characteristic. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.

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Quality of Life

Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.

Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more — within an easy drive of major East Coast cities.

York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)

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