Payment Compliance Analyst (REMOTE)

(Full Time, Remote)

The Analyst is responsible for the maximization of reimbursement by identifying contractual variances between posted and expected reimbursement revenue opportunities for managed care, government contracts, and other various payers. This responsibility encompasses contractual reimbursement analysis and communication of payment discrepancies to internal and external departments.

As a Payment Compliance Analyst at PCCM/CHS Shared Service Center - Nashville, you’ll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including health insurance, flexible scheduling, 401k and other elective benefit programs.

Essential Duties and Responsibilities include the following. Other duties may be assigned: 

• Identify trends in underpayment/overpayments, denials, revenue opportunities and revenue leakage
• Evaluate trends and works towards resolution and improvement of revenue cycle processes
• Interpret contract reimbursement and provide feedback to management staff as required
• Manage underpayment appeals, account follow-up and payer relationships
• Compile and analyze data to make recommendations
• Work with financial and clinical departments collaboratively
• Review contract validation, updates and interpretation
• Resolve underpaid claims in an effective and timely fashion
• Review payer policies for impact on reimbursement
• Present data to various end users
• Compile and validate account analysis prior to distribution
• Research and identify payment discrepancies from various sources
• Other duties as assigned

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Highly organized
• Initiative to work independently
• Proficient with telephone and email communications
• Basic understanding of medical coding systems affecting the adjudication of patient accounts in EDI or UB04 form,      

      including:  ICD-9, CPT, HCPCS, DRG, APG, APC, and revenue code structures

 Reasoning Ability:

The analyst must have the ability to define problems collects data, establish facts, and draw valid conclusions. The analyst must have the ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

 Computer Skills:

To perform this job successfully, an individual should have:

• Interest and aptitude in computer-based applications for complex business processes involving Boolean expressions,

       symbolic representation and procedural logic

• Required PC competencies including intermediate Microsoft Office skills

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 Education/Experience/Skills:

• High School graduate or equivalent
• Minimum of 1 (one) year of hospital revenue cycle experience or equivalent work experience
• Excellent interpersonal skills required to communicate with direct staff and internal/external customers
• Must possess excellent time management and organizational skills with great attention to detail
• Maintain applicable continuing education requirements
• The ability to work on multiple projects/initiatives at a time

We know it’s not just about finding a job. It’s about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.

Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.

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