Reimburse Recovery Analyst Sr

The Reimbursement Recovery Analyst Sr oversees managed care claims within PFS, which are denied or not processed according to the contract terms. Manages claim appeals with timely follow up. Analyzes payments via managed care software per contracts. Oversees the resubmission of claims for additional payment and maintenance of reports. Maintains knowledge of managed care contracts and problem solves within PFS with regard to contract questions/processes. Initiates verbal/written communication with the management team to bring resolution to obstacles from managed care companies and departments. Responsible for doing analysis of payers for managed care JOCs and projects as assigned. In charge f timely analysis and completion of payer files, including pipelines, escalations, Managed Care JOCs and special projects.

- Require a minimum of seven (7) years of managed care and/or reimbursement schedules experience.

- Prefer demonstrated experience in processing health insurance claims.
- Prefer demonstrated knowledge with ICD-10, CPT, DRG and Revenue codes.
- Prefer familiarity with managed care contracts and Florida statutes as they pertain to managed care operations.
- Prefer demonstrated proficiency with commonly used computer applications and strong analytical computer skills.
- Prefer the ability to demonstrate excellent communication and interpersonal skills.
- Prefer demonstrated ability to establish and maintain effective working relationships.

BD: Bachelor Degree

CPC: Certified Professional Coder
CRCS: Cer.Revenue Cycle Spec