Managed Care Revenue Optimization Analyst - FT - Days - MSS - Hybrid Eligible

Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Reviews and analyzes denials and short payments received from insurance plans to determine best plan for resolution. Takes action required to obtain payment in accordance with the terms of payor contract, applicable billing guidelines and/or Federal and State laws. Responsibilities: Responsible to meet and maintain production and quality standards defined by department policies and procedures. Reviews and analyzes managed care balances related to short payments, denials or those aged with no response. Evaluates the authorization, coding, billing and correspondence to identify underlying issue and determine best course of action to be taken to collect. Compiles detailed written appeal document outlining position for payment. Tracks outcomes of requests for payment to ensure timely identification of additional actions needed. Reconciles and updates business system and reports with findings and formalizes appeal documents required for follow up action. Interacts directly with Department Clinical Team as needed to obtain pertinent clinical facts needed to support medical necessity of services provided. Creates and maintains spreadsheets of open accounts. Works directly with plan contacts to exchange data, identify root causes of issues and reconcile data to confirm resolution. Responsible for identifying and reporting to Management payment and denial trends for assigned payors. Competencies: ACCOUNTABILITY, ACCURACY, CUSTOMER SERVICE, MANAGED CARE COMPLIANCE APPEALS AND TRENDING, PROBLEM SOLVING, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR, TEAM WORK, WORKLOAD MANAGEMENT Education and Certification Requirements: High School Diploma or Equivalent (Required) Additional Job Information: Complexity of Work: Requires critical thinking and effective communication skills. Must be able to demonstrate ability to make independent decisions. Requires detailed knowledge of government and managed care insurance terminology and reimbursement methodologies. Must have knowledge of federal and state regulations and laws/statutes related to payment for medical services. Requires knowledge of proper billing and coding of hospital services. Must be able to formulate and write formal business communications. Intermediate knowledge of Microsoft Word and Excel. Required Work Experience: Two (2) years experience working in a hospital/physician business office, managed care collections or managed care claims environment required. Working Conditions and Physical Requirements: Bending and Stooping = 40% Climbing = 0% Keyboard Entry = 80% Kneeling = 0% Lifting/Carrying Patients 35 Pounds or Greater = 0% Lifting or Carrying 0 - 25 lbs Non-Patient = 40% Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0% Lifting or Carrying > 75 lbs Non-Patient = 0% Pushing or Pulling 0 - 25 lbs Non-Patient = 40% Pushing or Pulling 26 - 75 lbs Non-Patient = 0% Pushing or Pulling > 75 lbs Non-Patient = 0% Reaching = 0% Repetitive Movement Foot/Leg = 0% Repetitive Movement Hand/Arm = 60% Running = 0% Sitting = 60% Squatting = 0% Standing = 60% Walking = 60% Audible Speech = 80% Hearing Acuity = 80% Smelling Acuity = 0% Taste Discrimination = 0% Depth Perception = 60% Distinguish Color = 60% Seeing - Far = 60% Seeing - Near = 60% Bio hazardous Waste = 0% Biological Hazards - Respiratory = 0% Biological Hazards - Skin or Ingestion = 0% Blood and/or Bodily Fluids = 0% Communicable Diseases and/or Pathogens = 0% Asbestos = 0% Cytotoxic Chemicals = 0% Dust = 40% Gas/Vapors/Fumes = 0% Hazardous Chemicals = 0% Hazardous Medication = 0% Latex = 0% Computer Monitor = 80% Domestic Animals = 0% Extreme Heat/Cold = 0% Fire Risk = 0% Hazardous Noise = 0% Heating Devices = 0% Hypoxia = 0% Laser/High Intensity Lights = 0% Magnetic Fields = 0% Moving Mechanical Parts = 0% Needles/Sharp Objects = 0% Potential Electric Shock = 0% Potential for Physical Assault = 0% Radiation = 0% Sudden Decompression During Flights = 0% Unprotected Heights = 0% Wet or Slippery Surfaces = 0% Shift: Days Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification. Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process. Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity. Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law. We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program. Employment is subject to post offer, pre-placement assessment, including drug testing. If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email TalentAcquisitionCenter@mhs.net Be where care matters. At Memorial Healthcare System, we are dedicated to improving the health, well-being, and quality of life of the people entrusted to our care. This unwavering commitment to our service vision makes the difference and is the foundation of The Memorial Experience. Deeper Caring. Smarter Healthcare. Talk to our patients and their families about “Deeper Caring,” and they'll tell you stories about miracle babies, lives saved through sheer determination, and the comforting kindness of others. About people who advocated for the family’s best interests and cared for them in body, mind, and spirit. For our employees, “Smarter Healthcare” means constantly improving how we deliver care. It could be a new technology, a streamlined process, or a cutting-edge program leveraging our system strengths. But, no matter how you look at it, our service vision is integral to our culture today and what we strive to be tomorrow. We invite you to share in the Memorial Experience – where touching lives, lifting spirits, and healing the human body is our profession’s greatest privilege and reward. Be where you are valued. Memorial Healthcare System provides preference as part of our commitment to honoring the service and sacrifice of veterans in alignment with state regulations. Veteran’s Preference allows for the first choice in interviewing, hiring, retention, and promotion after deployment when all other applicant qualifications are equal. However, Veteran's Preference does not guarantee a job. Who is eligible for Veteran’s Preference? We are proud to offer preference to internal and external applicants who identify within these categories: veterans, disabled veterans, spouse of a disabled veteran, unremarried veteran widow/widower, certain family members, active reservists and members of the National Guard. What should I do if I am eligible for Veteran’s Preference? You must claim your Veteran’s Preference status on your application. If selected for a job, you must provide documentation regarding your status. How does Memorial verify that someone is eligible for Veteran’s Preference? We require specific documentation as determined by the basis for which someone claims preference. For example, the documentation for a disabled veteran is different from the documentation required for the spouse of a veteran killed in the line of duty. How often can an eligible person claim Veteran's Preference at Memorial? There is no limit to how often internal or external applicants can use preference when a job is posted externally on our career website or elsewhere. What if there are two equally qualified, preference-eligible job applicants? In this case, the selection is based on the eligibility category in accordance with Florida law. First preference is given to: An honorably discharged veteran who has served on active duty and has a service-connected, compensable disability. A spouse of a person who has a total, permanent, service-connected disability and cannot qualify for employment. A spouse of a person missing in action, captured or forcibly detained or interned by a foreign government or power. What do I do if I am denied Veteran's Preference? If you feel you have been unfairly denied Veteran’s Preference by Memorial Healthcare System, please contact EmployeeRelations@mhs.net. You may also file a complaint with the Florida Department of Veterans’ Affairs (FDVA). 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