Providence Health & Services Reimbursement Analyst - Audit and Recovery in Portland, Oregon
Providence St. Joseph Health is calling a Reimbursement Analyst- Audit and Recovery to our location in Portland, WA.
We are seeking a Reimbursement Analyst- Audit and Recovery who will be responsible for identifying, collecting and determining root causes of underpaid claims by auditing payor performance and analyzing actual payments of payors to ensure contract compliance which is operationally critical and sensitive in nature. This includes utilizing independent judgment to compare actual reimbursement to expected reimbursement, reviewing managed care contract terms, claims billing and clinical information to effectively reconcile underpaid accounts and maintain documentation to support this activity. This requires expert knowledge of health care reimbursement and contracting and the use of deductive reasoning, negotiating skills and collaborative skills to uncover and recover payment discrepancy in a complex system and complex payer environment.
The analyst will participate in regular meetings with managed care payor representatives and present payment discrepancy patterns and issues using actual claim examples. The analyst will make recommendations to reduce future underpayments, minimize the risk of future cash loss and provide information for future contract negotiations. Must maintain knowledge of complex and changing regulatory and payor requirements and payment methodologies. This position has responsibility to contribute to the accuracy of our expected reimbursement calculation systems by assisting with routine audits of contract loads and rapid response to calculation errors found in the systems. This position will process operational variances (false variances) which impact data integrity and compliant billing according to established guidelines in collaboration with ORC.
In this position you will have the following responsibilities:
Utilize independent judgment and exercises discretion to ensure timely review and auditing of underpaid claims.
Analyze, collect underpayments and resolve claims with discrepancies from expected payment to ensure payors are in payment compliance with their contracted terms.
Initiate and follow through with all relevant parties to ensure corrective actions are implemented (i.e., pursue underpayments, adjust expected reimbursement, address billing issues, negotiate settlements, etc.) according to payer specific processes.
Respond to payment discrepancies by creating appeal letters and articulating contract provisions to representatives from third party payers. Works directly with payor to recover payments.
Consistently maintain productivity and accuracy standards in highly challenging environment.
Identify patterns, trends, and root-causes in collection issues and payor performance. Provide information on global payor issues and assist in preparing utilization data to work with payors on collecting additional funds in most efficient manner possible (spreadsheet, project, mass rebill, etc.).
Make recommendations to reduce future underpayments, minimize the risk of future cash loss and provide information for future contract negotiations.
Build and sustain relationships across multiple disciplines, agencies and departments.
Contributes to the accuracy of our expected reimbursement calculation systems by assisting with routine audits of contract loads, validating calculations and rapid response to calculation errors found in the systems during daily work processes.
Strive to continually drive exceptions out of the insurance payment process by documenting, trending, reporting and understanding the cause of exceptions.
Maintain accurate, clear and complete documentation on all accounts in the systems.
Maintain current knowledge of payor policies and contract terms. Keeps current on government program participation rates and stays informed of rules and regulations that pertain to payment methodologies and reimbursement practices.
Maintain proficiency in all business systems used in this role (Epic, Concuity, Med Assets, etc.).
- 4 years experience in some aspect of Revenue Cycle or Health care finance.
Associate's Degree or equivalent education/experience.
2 years experience with managed care contracts.
About the department you will serve.
Providence Shared Services provides a variety of functional and system support services for our Providence family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Reimbursement
Req ID: 316257