Marshall Health Network
Marshall Health Network is seeking a full-time Managed Care Analyst. Position responsible for ensuring accuracy of third party insurance payments according to contractual and state/federal reimbursement guidelines and policy. Identifies underpayments and works with patient accounting department and third party payor to resolve/appeal. Assist in payor relations and provider contracting. Maintains contract management pricing software. Negotiates single case agreements. Assist in preparation, maintenance, and compliance of pricing transparency requirements and disclosures. Assist in various other financial analysis including:
Follows standards of conduct and procedures of hospital and applicable laws and regulations and reports violations through appropriate chain of command. Performs regular payment reviews of high risk underpayment areas. Reviews payer updates and provider news releases. Follows HIPAA guidelines to ensure patient privacy and security. Audit patient accounts to reconcile missed or incorrect payments. Utilizes technology to maximize review process efficiency. Maintains a level of persistency when pursuing an underpayment from a third party payer. Document projects and underpayment recovery collections and efforts. Identifies opportunities to maximize third party reimbursement.
Bachelor's degree required; Master's degree preferred.
CPA or Law Degree is preferred.
2 to 5 years of position related experience is required.
Experience in the following: Knowledge of healthcare reimbursement methodologies and experience in collection of unpaid receivables. Interpretation and understanding of state specific laws regarding health insurance business practices. Strong data and analytical skills.
Follows standards of conduct and procedures of hospital and applicable laws and regulations and reports violations through appropriate chain of command. Performs regular payment reviews of high risk underpayment areas. Reviews payer updates and provider news releases. Follows HIPAA guidelines to ensure patient privacy and security. Audit patient accounts to reconcile missed or incorrect payments. Utilizes technology to maximize review process efficiency. Maintains a level of persistency when pursuing an underpayment from a third party payer. Document projects and underpayment recovery collections and efforts. Identifies opportunities to maximize third party reimbursement.
Bachelor's degree required; Master's degree preferred.
CPA or Law Degree is preferred.
2 to 5 years of position related experience is required.
Experience in the following: Knowledge of healthcare reimbursement methodologies and experience in collection of unpaid receivables. Interpretation and understanding of state specific laws regarding health insurance business practices. Strong data and analytical skills.