Revenue Recovery and Contract Analyst

ABOUT AUSTIN REGIONAL CLINIC:

Austin Regional Clinic has been voted a top Central Texas employer by our employees for over 15 years!   We are one of central Texas’ largest professional medical groups with 35 locations and we are continuing to grow. We offer the following benefits to eligible team members: Medical, Dental, Vision, Flexible Spending Accounts, PTO, 401(k), EAP, Life Insurance, Long Term Disability, Tuition Reimbursement, Child Care Assistance, Health & Fitness, Sick Child Care Assistance, Development and more. For additional information visit https://www.austinregionalclinic.com/careers/

PURPOSE

Responsible for review, coordination, and appeal of denied and underpaid claims. Prepare appeals, discuss denials with payer representatives and monitor outcomes of follow-up activities. Carries out all duties while respecting patient confidentiality and promoting the mission and philosophy of the organization supported.

ESSENTIAL FUNCTIONS

Contract Manager

• Completes financial impact analysis of contract negotiations, including modeling of contract proposals, reporting of contract proposal impact, performance and quantifying financial impact of these proposals for future year(s) and developing alternative proposals within the budget parameters. Presenting analysis and recommendations to leadership.
• Interprets managed care contract terms and validates understanding and model relevant parameters into contract model application for contracts. Reviews all Managed Care contracts and amendments as received to ensure that all contracts in system are current and calculating correctly.
• Evaluates underpayments and overpayments for possible overturn opportunity and identifies contract update needs.
• Generates and submits individual or mass appeals, creates appeal letters and/or works with payer representative to submit appeal projects.
• Tracks appeals and recoveries and performs regular follow up on outstanding appeals.
• Reports possible contract and payer discrepancies and/or recommends contract record updates as necessary.
• Communicates payer contracting/fee schedule issues impacting claims to CBO management and prepares monthly reports.
• Identifies and escalates consistent issues and trends with payers to support leadership in meeting with payers to resolve issues.
• Serves as point of contact for fee schedule allowed amount inquires.
• Submits Experian support requests regarding contract record or claim valuation inquiries.
• Works closely with Revenue Integrity leadership to understand contract specifics and provide the contracting team with data to support negotiations with payers.

Epic Claims Follow up

• Utilizes In-Basket to communicate with clinic staff and obtain information and authorization to edit claims.
• Researches insurance payments and X12 Claim Adjustment Reason Code/Remittance Advice Remark Code denials to determine correct posting information.
• Utilizes Payer/Storage portals for claims status or eligibility.
• Opens, closes, and process batches according to departmental guidelines.
• Generates any adjustments necessary to complete posting of payments.
• Uses appropriate Functions when performing actions as described through Account Maintenance.
• Maintains and follows up on accounts appropriately and documents all activities and results through Account Contact.
• Reviews accounts for credits and request refunds to Insurance Companies or Patients, as necessary.
• Obtains signature of approval for any adjustments over $750.00.
• Informs and works with management team when all usual attempts to collect from third parties and/or customers have failed to result in adequate reimbursement.

Work Queue Maintenance

• Manages accounts assigned to the work queues using Work Queue Ticklers.
• Places account notes in Account Contact to document all activities and results.

Correspondence

• Maintains correspondence levels to no more than 7 days’ backlog.
• Posts zero payment EOBs / correspondence using a Payment Posting Batch.
• Reviews Work queue Summary for each correspondence account and completes from Work queues as appropriate.
• Responds to Patient/Customer to confirm receipt of / or provide resolution to written correspondence.

Registration 

• Forwards requests for registration verification and updates the Registration team.
• Adds a termination date to patient coverage when a claim is denied for “coverage termed.”

OTHER DUTIES AND RESPONSIBILITIES:

• Processes claims in Epic Account Maintenance.
• Provides call-center back-up to Customer Service and Registrations teams.
• Meets performance standards in Patient Registration and Posting.
• Keeps complete, accessible, updated files.
• Verifies insurance eligibility and sets up accounts by account type classifications.
• Aids coworkers as requested and/or necessary.
• Provides workload statistic reports to management team.
• Responds professionally and effectively to questions from external sources, i.e., customer or carrier, and internal sources, i.e., provider or management team.
• Attends required in-services/training sessions.
• Works overtime when requested by unit/department/clinic procedures.
• Follows rules and regulations of Covenant Management Systems as described in the employee handbook and in the unit/department/clinic procedures.
• Performs other duties as assigned.
• Has consistent and dependable attendance.

QUALIFICATIONS

Education and Experience

Required:  High school diploma or equivalent. At least three (3) years of experience working with Epic billing, claim denial management and registration modules, or with managed care contracts. and understands payer payment methodologies. At least two (2) years of experience working with accounts receivables to include effectively pursuing payments from carriers and customers. 

Preferred: Experience working with CMS/ARC billing & collections functions.

Knowledge, Skills and Abilities

• Excellent customer service skills.
• Knowledge of and/or experience with billing and collecting from Medicare, Medicaid and Commercial Insurance.
• Basic knowledge of insurance contracts and fee schedules.
• Knowledge of and/or experience with procedural and diagnostic coding.
• Knowledge of patient copay vs. cost share responsibility.
• Knowledge of legislative and private sector third party regulations and guidelines.
• Strong skills with Microsoft Excel and computer data processing systems.
• Ability to sit for extended periods of time at a computer workstation.
• Excellent verbal and written communication skills.
• Excellent interpersonal & problem solving skills.
• Ability to work in a team environment.
• Strong analytical and problem solving skills.
• Ability to engage others, listen and adapt response to meet others’ needs.
• Ability to align own actions with those of other team members committed to common goals.
• Excellent verbal and written communication skills.
• Ability to manage competing priorities.
• Ability to perform job duties in a professional manner at all times.
• Ability to understand, recall, and communicate factual information.
• Ability to organize thoughts and ideas into understandable terminology.
• Ability to apply common sense in performing job.

Schedule: Monday - Friday, 8am - 5pm