Halifax Health is seeking a Recovery and Reimbursement Analyst.
This individual serves as an operational subject matter expert ensuring that Halifax Health receives appropriate payment for delivered services. Works as part of a team as well as independently to ensure identified payment variances for managed care, government contracts and other various payers are resolved in a timely and compliant manner. Key focus of the Recovery Reimbursement Analyst is reimbursement analysis, payment resolution with timely follow up on all assigned accounts, appropriate account adjustment and comprehensive documentation in the applicable hospital systems.
This role is responsible for working with diverse groups within the organization and contracted payers to analyze and understand underpayment root causes and to develop thorough collection techniques to contribute to overall payment resolution. This requires a thorough understanding of Patient Financial Services functions (hospital patient access requirements, claims processing, collections and remittance posting) in addition to hospital contract specifics.
The Recovery Reimbursement Analyst is responsible for working to identify and then resolve systemic issues that cause revenue capture inefficiencies. The individual will perform specific areas of review, follow up, recovery and account resolution for third party payer underpayments and denials of hospital patient accounts through the use of streamlined collection techniques and appeals.
Evaluates variances on paid claims.
Performs contract analysis to validate accuracy of programmed contract rules.
Works independently to identify collectable underpaid amounts through appeal or reconsideration.
Ensures reimbursement and follow up is accurate, timely and compliant.
Initiates timely appeals and reconsiderations with payers by telephone, letter, email or other electronic media or spreadsheets.
Perform follow up with regulatory agencies as may be required for challenged claims.
Track and document underpayment reconsideration and appeals in contract management system.
Accurately calculates and enters adjustments into the host system while appeals are pending. Ensures that batches are finalized at the close of business daily.
Documents all activities in the contract management system.
Assists with appeals for technical denials as needed.
Addresses aged accounts in a timely manner to reduce Accounts Receivables and maximize reimbursements due under contract.
Assists in efforts to maintain contract/ underpayment calculation integrity by monitoring system issues and serves as a liaison between Managed Care Recovery and PFS IT.
Participates in team development projects and offers solutions to identified payer issues.
Mentors new team members as directed.
Assist other departments perform claim analysis as needed.
Assimilates documentation to support reconciliation or appeal.
Identified and reports data and collection trends/ barriers to claim resolution.
Meets and/or exceeds production goals as defined.
Other duties as assigned.
Recognized by The Joint Commission as a Top Performer on Key Quality Measures, Halifax Health serves Volusia and Flagler counties, providing a continuum of healthcare services through a network of organizations including a tertiary hospital, community hospital, psychiatric services, a cancer treatment center with four outreach locations, the area’s largest hospice, a center for inpatient rehabilitation, primary care walk-in clinics, a walk-in clinic specializing in women’s health, two community clinics, three children’s medical practices, a home healthcare agency, and an exclusive provider organization. Halifax Health offers the area’s only Level II Trauma Center, Comprehensive Stroke Center, Pediatric Intensive Care Unit, Pediatric Emergency Department, Child and Adolescent Behavioral Services, complete Neurosurgical Services, OB Emergency Department and Level II Neonatal Intensive Care Unit that cares for babies born as early as 28 weeks. For more information, visit halifaxhealth.org.