Job Posting Closing Date: Open until Filled
Where do you belong?
Your career is more than just a job, it's part of your life. Whether you’re a clinician, or non-clinical professional, at USACS you'll feel a sense of connection working with clinicians and office staff who share your interests and values. We want you to love coming to work each day because you believe in what you do and the people with whom you work. We care about your success.
USACS also understands that location is important. We offer career opportunities for clinicians and non-clinical support staff from New York to Hawaii and numerous points in between. Our supportive culture, outstanding benefits and competitive compensation package is best in class.
Job Description
Handles administration of contracts, including comprehensive review and processing. In addition, individuals will be accountable for payer and revenue analytics, payer contract compliance, and systems monitoring.
ESSENTIAL JOB FUNCTIONS:
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Track and monitor contracts throughout their lifecycle from inception to execution and post-implementation.
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Establish and maintain positive relationships with health care plans to facilitate the sharing of information, analysis, and other information important to the provider/payer relationship.
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Accountable for creating and maintaining the contract management database as appropriate.
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Responsible for extracting crucial contractual terms based on language review of new or renegotiated contracts and/or amendments and inputting essential data into the contract database for utilization by other external departments.
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Accurately interpret contractual rate terms within the contract language for each product line encompassed to ensure the correct expected rates are loaded into the billing system.
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Timely & accurately obtain and verify contracted payers’ process for provider enrollment, APP billing requirements, and any special claims set up requirements and notify appropriate departments as necessary.
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Research commercial & government payer websites and/or communicate with payers to obtain and maintain current payment policies, modifier reductions, fee schedules, APP billing guidelines and APP reimbursement policies.
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Properly calculate fee schedules utilizing Excel per the contractual percentages and terms based on the calculation method identified in the contract including but not limited to; RVU, percent of Medicare, percent of payer standard.
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Precisely format fee schedules per approved current standards and guidelines and timely update all appropriate areas of the contract database as necessary.
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Timely convey changes in fee schedules, APP guidelines, and modifier reductions to other essential departments.
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Generate and analyze changes in carrier standard rates and government rates to determine the projected increase/decrease in revenue and report revenue changes to department leadership.
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Audit existing payer contracts to ensure proper payment and reduction policies are implemented in both our system and the payer’s system per contractual agreement.
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Analyze claims data utilizing Excel and other tools to ensure proper payment per contractual agreement.
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Identify emerging reimbursement issues and communicate to department leadership
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Collaborate with payer to resolve contractual issues, including but not limited to, claims payment, fee schedules, and assist with internal resolution.
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Facilitate notification to contracted payers in a timely fashion of new service locations with payer specific required information
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Create, maintain, and update multiple matrixes of all contracted and national payers for management and tracking of new group/location notification and follow up
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Monitor contracted payer claims for new service location to ensure claims are reimbursed per the contractual agreement.
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Prepare accurate and current provider rosters with payer’s required information utilizing current provider data bases.
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Research government and out of network billing and enrollment processes as necessary.
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Investigate and resolve claim denials for in network and out of network provider enrollment issues.
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Ensure all communication with payer and other departments is imported and saved to the contract database.
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Accountable for meeting or exceeding departmental performance standards and time sensitive deadlines as defined.
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Work independently within scope of responsibility and authority.
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Understands and follows rigorous state and health plan requirements, determines tasks priorities, and escalates issues requiring management approval or special processing requirements.
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Ability to work with high volume projects while multi-tasking.
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Understand and adhere to current departmental and company policies, procedures, and guidelines.
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Responsible for the lifecycle of the integration of existing contracts as new integration(s) occur within the contract management database and all necessary departments.
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Maintain tracking and tasks for the integration of existing contracts as new integration(s) occur.
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Perform other duties and projects as assigned.
KNOWLEDGE, SKILLS AND ABILITIES:
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Knowledge of and skill in using personal computers in a Windows environment.
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Basic expertise of Microsoft Office products, with advanced expertise in Excel. Including knowledge of various functions (i.e. VLOOKUP, Pivot Tables, etc.)
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Knowledge of healthcare industry including billing and claims, medical coding, payer/provider relations, contracting processes, fee schedules, and reimbursement methodologies.
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Ability to access and research payer and regulatory statutes related to healthcare.
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Ability to access and research claim issues on payer websites.
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Skill in operating various office equipment such as personal computer, calculator, facsimile, copy machines, document shredder, and scanner.
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Ability to work well under pressure and meet strict deadlines.
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Strong analytical and problem-solving skills.
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Ability to organize and prioritize job tasks and requirements.
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Ability to use solution-focused problem solving and to think through problems creatively.
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Ability to communicate with employees, management, and payer representatives in a courteous and professional manner.
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Must have good working knowledge of correct English and grammar usage in verbal and written communications.
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Ability to effectively perform in a multi-task work environment and adapt to change in a positive manner.
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Ability to work overtime as needed.
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Ability to comply with Federal and State laws and regulations pertaining to patient care, patients’ rights, safety, billing, and collections.
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Adhere to all departmental policies and procedures.
EDUCATION AND EXPERIENCE:
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High school diploma required or equivalent, college coursework or equivalent relevant medical billing, payment processing, and analysis experience.
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Experience in Appeals, Follow Up, or Patient Services required.
PHYSICAL DEMANDS:
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While performing the duties of this job, the employee is regularly required to sit for prolonged periods and occasionally walk, stand, bend, stoop, and lift up to 15 pounds.
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Required to have close visual acuity to perform job
Hourly Rate: $18.76 - $34.70
Hourly rate may be determined on several factors including but not limited to knowledge, skills, experience, education, geographical location and requirements stated in job description.
US Acute Care Solutions current and potential employees enjoy best in class benefit programs with a wide array of options. To learn more, please visit the following link:
https://www.usacs.com/benefits-guide-2024
Click the red apply button to submit an application and resume. If you are an USACS employee, please apply via the Jobs Hub in the Workday system.