Reimbursement Management
Reimbursement Management
Under the general supervision of the CDM and Reimbursement Manager the Reimbursement and RAC Analyst (RRA) will be responsible for reducing denied claims to improve hospital operating margins. The RRA will maintain the RAC database to track Recovery Audit Contractor requests and denials from commercial and government payers including the review and logging of EOBŐs with denials. Follow-up with point of service departments to resolve underlying issues that resulted in the denial of claims. Track the entire process of the denied claim from receipt of the explanation of benefit (EOB) to the resolve of the case to include contacting the HIM department for the submission of medical records, speaking with the utilization review team or Case Managers, and physicians. The RRA will be responsible for compiling a comprehensive spreadsheet and summary report to be submitted on a biweekly basis to all affected departments or medical staff. This position will be responsible for heading up biweekly denial group meetings to discuss and resolve reimbursement issues and RAC related correspondence within the last two weeks. Immediate resolution and resubmission of claims are expected.
This position is responsible for reading and understanding each payer contract to recognize contractual agreements and review accounts to ensure adjustments were made accordingly and EOB postings are appropriate to the procedure line item. The Reimbursement and RAC Analyst will be responsible for reporting discrepancies in the posting of adjustments of EOBŐs if applicable. This position will work with and communicate effectively with the staff of the Business Office for the resolution of denied claims and all other business related functions for the benefit of the organizations growth. Develop relationships with various revenue driven areas to show trend analysis and data storage to track, trend, and determine collectability, to zero in on the root causes of denials to drive front end solutions. Participates in continued education offered by the facility to improve the employees understanding of the duties and to foster increased competence in the area of work. The RRA will be responsible for maintaining the RAC Audit Tool.
Apply Now