Title: Senior Reimbursement Business Analyst
Location: Plymouth MN
Duration: 5+ Months
Position Summary:
The Senior Reimbursement Business Analyst is responsible for business process review and provide daily, monthly, quarterly and annual reports related to reimbursement. Applies six-sigma approach to ensure operational efficiencies. The Senior Reimbursement Business Analyst is responsible for owning project goals by developing project plans, establishing deadlines, monitoring milestone completion and providing timely reporting of issues that impact progress and the resolution of conflicts. This role is responsible for working cross-functionally and interacts with all levels of Management. He/she will serve as the subject matter expert (SME) on multiple projects representing the department regarding reimbursement methodology and will assist Management by analyzing data, identifying root causes and making recommendations.
Analytics and Reporting(65%)
§ Identify defects and improve accurate provider payment by performing root cause analysisrelated to the pre and post claim submission process
§ Performs routine and targeted data analysis on claim and authorization denials
§ Monitors trends and responds quickly to changes in day sales outstanding (DSO); collaborates with SME’s and management to drive awareness of improvement or decline in the timely and accurate payment of claims
§ Creates, publishes and communicates department reports on a daily, monthly, quarterly and annual basis
§ Applies six-sigma methodology to identify opportunities to minimize DSO, rework or appeals and enhance productivity and quality
Project Management (20%)
§ Understands and communicates project concepts, objectives and approach related to reimbursement
§ Conducts testing and maintains accurate documentation and meets timelines for assigned projects
§ Responsible for the overall success of applicable testing, including results verification before leadership sign-off and implementation to production
§ Solicits input and expertise from other teams and/or SME’s impacted by process improvement projects
§ Publishes monthly, quarterly and annual reports related to reimbursement projects
§ Prioritizes and communicates project progress to management
Other Duties and Responsibilities: (15%)
§ Attends HIPAA training and other training sessions as required
§ Understand and comply with all applicable company policies and procedures
§ Understand and comply with all applicable local/state/federal regulations related to the medical device and durable medical equipment industries
§ Assists management in internal and external audits
§ Participates in company meetings, as necessary
§ Performs other duties as assigned
Required Qualifications:
§ Bachelor’s degree preferred or equivalent work experience
§ Minimum fiveyears’ experience in insurance, reimbursementand/or claims billing, preferably with some experience in a Durable Medical Equipment (DME), clinical, payeror healthcare-related business with a minimum of two years’ experience as a reimbursement analyst
§ Documentation of successful completion of Six Sigma program
§ Knowledge of healthcare compliance and regulatory reimbursement and insurance-related requirements
§ Working knowledge of medical terminology and HCPCS and ICD-10codes
§ Excellent communication skills, both verbal and written
§ Demonstrated superior customer service skills
§ Process and detail oriented
§ Strong computer skills, with advancedknowledge of word processing, spreadsheet, presentation and database software, such as Microsoft Office.
§ Exceptional analytical and problem solving skills in complex situations
§ Ability to work independently and as part of a team
§ Strong skills in fostering cross-functional working relationships
Physical Requirements of the Position:
Must be able to sit at computer desk in front of a PC Monitor for long periods of time. Position requires use of a PC, telephone, fax, and basic office equipment. Position requires ability to engage in telephone conversations, read medical and insurance information and communicate clearly with all levels of internal and external customers.