The Payment Validation Analyst works under the supervision of the Director of Revenue Integrity. Responsible for ensuring accurate payment is received from payors, including line level payment validation where appropriate.
Responsibilities
Remote States: Candidates residing in the following states will be considered for remote employment: Alabama, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Mississippi, Nebraska, North Carolina, Oklahoma, Texas, Utah, and Virginia. Remote work will not be permitted from any other state at this time
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Responsible for analyzing contractual underpayments. Identify and resolve daily encounters holding in Epic WQs for contractual underpayments. Identify root cause and work on corrective action implementation.
Responsible for resolving encounters in Epic WQ for price/contract discrepancy. Identify root cause and work with CDM Analyst/Revenue Integrity Analyst to implement fee schedule correction, and/or identify root cause causing the discrepancy.
Works on rebill projects focused on recoupment of underpayments.
Subject matter expert regarding payer reimbursements and contracts. Be informed of changes to payer reimbursement and work with CDM Analyst and/or Revenue Integrity Analysts to implement changes, if and as needed.
Research non-covered and/ or denied charges to identify root causes. Works with the Revenue Integrity Manager to assist with appeals.
Identifies Coding, Charging, and/ or Billing issues/ patterns that are resulting in inaccurate payment and works with/ educates the appropriate staff to resolve them. Monitors and tracks accounts that have been identified for re-billing to ensure proper payment is ultimately received.
Utilize Epic reports to prepare monthly measurement reports regarding any/ all findings, follow-up actions taken, and any recommendations that need DIRECTOR or above approval.
Creates and maintains contracts in Epic.
Assists with the start-up process for new programs. Helps to identify services that are reimbursable but are not being coded or charged for.
Research and resolves CPT code, revenue code and other charge master related issues referred by the Patient Financial Services, Coding, or Revenue Integrity departments.
Coordinates routine individual projects by planning and organizing project steps.
Utilizes logical sequential steps and understands flowchart techniques with minimal direction when working on projects.
Other duties as assigned
Education
Bachelor's Degree - Required
H.S. Diploma - Required
Work Experience
5 Years - Health care experience. Minimum five years' experience and knowledge of hospital financial operations including reimbursement, Medical Billing, Charge Master Development and Maintenance, Medical Records/Coding and Charge Audit experience. - Required
5 Years - Broad based knowledge of hospital financial operations including reimbursement, coding and charge master development and maintenance. - Required
5 Years - In-depth knowledge of CPTs, HCPCs and ICD-10 medical coding, and related APC Medicare reimbursement. - Required
Licenses and Certifications
Epic Certifications - Epic Contracts Module Certification - Preferred Upon Hire
Travel Requirements
Travel to off-site locations may be required. - Required
Qualifications
Skills and Abilities
Essential Technical/Motor Skills
Input data, type, manipulate calculator and small business equipment, speak clearly and professionally, answer telephone, copying.
Interpersonal Skills
Oral and written communication skills with staff, leadership, physicians and consultants on an individual basis as well as interaction on teams.
Essential Physical Requirements
Lifting, moving, reaching, bending, stooping, standing, walking, typing, operating small business equipment.
Essential Mental Abilities
Analyze, synthesize, evaluate, comprehend, explain, understand, forecast, interpret, manipulate numbers, interpret data, calculate, organize, plan, small and large group presentations.
Essential Sensory Requirements
Eyesight, hearing.
Exposure to Hazards
Electrical output of personal computer, eye/neck strain.
Other Skills and Abilities
Must be a highly energetic, motivated self-started.
Must have the ability to determine areas of concern.
Accuracy important 95% of the time.
Confidentiality important 100% of the time.
Mosaic Life Care is a health care system in northwest Missouri. With a vision of transforming community health by being a life-care innovator, Mosaic places the holistic needs of patients first by providing the right care at the right time and place, offering high value and quality health care.
Mosaic has a wide array of benefits to meet each employee’s individual needs. Our benefits were designed by listening to people just like you. Mosaic also offers several perks with a focus on ensuring our employees feel valued, including concierge services, employee lounge, wellness programs, free covered parking, free on-site and virtual health clinics and many more. When paired with compensation and recognition, it is what continues to make us the employer of choice for employees at any stage of their journey.
