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Role Description

The Contract Reimbursement Coordinator analyzes, researches, and reviews reimbursement reports as assigned by the department manager and is responsible for specific worklists related to open issues, projects, or special billing arrangements. The Coordinator will work between Athena and Legal Files systems to identify contract variances and manage high revenue impacting issues. The Coordinator is responsible for working with the carrier at management level to resolve outstanding payment issues in a timely manner while keeping all impacted areas within the company informed of their progress. The Coordinator coordinates federal NSA and local state negotiations and dispute resolution processes with department manager, USACS leadership, and all required external parties according to pre-defined timelines.

• Analyzes and researches reimbursement dashboards and Payment Mismatch reports to ensure all high dollar reimbursement variances are identified and worked timely.
• Manages high revenue impacting issues for assigned states.
• Coordinates with leadership on-site and at the facility when there are revenue impacting issues causing significant slowdowns in cash flow.
• Works closely with USACS leadership to manage and complete appeals and arbitration for out of network payers.
• Completes a monthly report on all outstanding issues to determine if payments are received and if volumes are increasing.
• Works with insurance carriers to fix system issues on both their end and USACS’s end to enable claim adjudication on first pass.
• Monitors assigned worklist inventory to ensure the appropriate claims are being captured and worked in a timely manner.
• Updates Legal files to make certain other departments are aware of how to handle existing issues when found in their regular workflow.
• Works closely with other departments within USACS to ensure all claims associated with high revenue impacting issues are captured for resolution and worked within a timely manner.
• Prepares a weekly update of all assigned outstanding issues to discuss the status with the department manager.
• Manages federal NSA and state open negotiation submissions and responses for assigned payer(s) and market(s).
• Initiates federal NSA and state arbitration disputes by consolidating supporting documentation and submitting essential materials to all required parties within strict deadlines.
• Monitors negotiation and arbitration submissions for issues and/or trends and then communicates those to department manager.
• Analyzes OON reimbursement trends to help identify negotiation and arbitration opportunities.
• Answers questions from other USACS depts. on CRA outstanding issues, projects, or special billing arrangements.
• Assists department with various claims projects and special billing invoicing.
• Performs and assists with other department duties as needed.

Qualifications

• High school diploma or equivalent.
• At least two years of medical insurance or billing experience or equivalent training or education.

Requirements

• Ability to negotiate with payers for final resolution of unpaid projects.
• Ability to unite multiple areas working different aspects of a project.
• Knowledge of contracted and non-contracted commercial and government payers and their reimbursement behavior.
• Ability to pay close attention to detail.
• Knowledge of state and federal laws and regulations.
• Knowledge of and skill in using personal computers in a Windows environment with an emphasis on intermediate to advanced word processing and more specific spreadsheet analysis.
• Knowledge of medical insurance and terminology.
• Intermediate knowledge of ICD-10 and CPT codes.
• Ability to identify, analyze, research and solve problems and discrepancies.
• Ability to maintain confidentiality.
• Ability to multi-task and process assigned duties in an organized manner.
• Ability to perform basic mathematical calculations such as adding, subtracting, multiplying and dividing.
• Ability to effectively perform in a multi-task work environment.
• Ability to work overtime as needed.
• Ability to identify emerging issues and communicate them to the department manager.

Physical Demands

• 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.
• Required to have close visual acuity to perform the job.

Compensation

• Hourly Rate: $18.76-$34.70/hour.
• 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.

Benefits

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: USACS Benefits Guide .

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