Third Party Reimbursement Analyst - 40hrs/Day Shift (Hybrid)

ABOUT US:

With energy and purpose, Cooley Dickinson Health Care, a member of the Mass General Brigham system, is advancing health care in western Massachusetts, and has been since 1886. Our network employs more than 2,000 medical professionals and support staff, at our main Hospital campus in Northampton and additional locations in twelve towns throughout the Pioneer Valley.

OUR BENEFITS:

In addition to competitive pay, all Cooley Dickinson employees who work 20 hours or more per week have access to the following benefits with no waiting period:

• A range of health, dental, vision, prescription, and life insurance benefits.
• A generous and flexible Earned Time Off program starting at six weeks accrual per year.
• 403(b) retirement plan with various investment options.
• Opportunities and support for continued education including tuition reimbursement.

SHIFT: Monday - Friday 8:00am-4:30pm, Hybrid 2 days onsite and 3 days remote (after 90 days of successful onsite training)

MAIN FUNCTION:

The Third Party Reimbursement Analyst maintains Cooley Dickinson Hospital’s contract management systems. The Analyst works closely with Finance, Patient Accounting, and the Reimbursement Department staff for both the Hospital and the Physician Billing Departments on contract and billing issues as well as other reimbursement related tasks. The Analyst collaborates with Massachusetts General Brigham Contract Management Staff and Reimbursement teams. The Third Party Reimbursement Analyst also develops strong working relationships with the managed care organizations and third party payers in attempts to collect amounts due the hospital.

This position reports to Manager of Patient Accounting and operates within established organizational and departmental policies and procedures.

ESSENTIAL JOB FUNCTIONS:

• Lead the activities related to the Harvest Contract Management System and coordinate information between Fiscal Services and the Payer contracting teams.
• Oversee the daily import and reconciliation, maintenance (contract terms, conditions, rates and mapping), and reporting of the contract management system and maintaining related documentation.
• Review and monitor payer billing policies, produce data to support various initiatives, including but not limited to identifying payer and claim related issues, develop financial analyses and support Fiscal Services, Payer Contracting and Revenue Cycle management teams at routine payer meetings.
• Investigate, research, and reconcile payments received from managed care organizations and other third party payers to assure payments are correct and within established terms for both the Hospital and CDMG.
• Maintain correct rates in the contract monitoring system, working to resolve discrepancies with payers and/or reimbursement staff. Collaborate with MGB contracting and reimbursement staff to remain in sync with the overall system.
• Develop processes to maintain the database in both contract management systems of CDH and CDMG to make available the best possible information around contracted services to be used by billing staffs, reimbursement staffs, strategic planning, and MGB payer relations.
• Provide analysis or support work as requested by reimbursement, billing and/or contract staff for both CDH and CDMG.
• Prepare/reconcile daily exception reports from third party reimbursement monitoring system.
• Using output from the third party reimbursement monitoring system that identifies incorrect payments received, contact the various third-party payers to collect underpayments according to hospital and departmental policy and procedures. Work with patient accounting staff to identify and refund overpayments made by third party payer organizations.
• Function as departmental third party reimbursement resource for questions relating to reimbursement, rates, and payment appropriateness.
• Assist in the development of financial models as needed by strategic planning or reimbursement staffs.
• Attend payer meetings and other reimbursement related meetings both with MGB and externally to stay up to date on current issues and to represent CDH and CDMG as required.
• Provide reporting and analysis as required by billing, reimbursement, or finance departments for CDH and CDMG.
• Work with billing staff as needed to address problem claim edits or suspensions by third party payer organizations.
• Maintain established hospital and departmental policies and procedures, objectives, confidentiality, quality improvement program, compliance, safety, infection control, and environmental standards.
• Maintain professional growth and development through attendance at seminars, workshops, conferences or in-services, professional affiliations, or journals to stay abreast of current trends in field of expertise.
• Meet annual competency and retraining requirements.
• Attend meetings as required.
• Perform other functions/duties as requested.

Mininum Requirements:

• High school diploma or equivalent required; college degree preferred
• Five to seven years previous healthcare billing or third party claims processing experience required
• Demonstrated proficiency in third party contract and payment methodologies
• Demonstrated proficiency with computers and spreadsheet applications required
• Candidate must be detail oriented, and self-driven with outstanding interpersonal skills and advanced analytical skills