Contract Compliance Analyst - Full Time - Days

Contract Compliance Analyst - Full Time - Days page is loaded

Contract Compliance Analyst - Full Time - Days

Apply locations Methodist Corporate Office - Omaha, NE time type Full time posted on Posted 3 Days Ago job requisition id JR30098

Why work for Nebraska Methodist Health System?
At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care – a culture that has and will continue to set us apart. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in.

Job Summary:

Work Schedule: 8am to 4:30pm

Responsible for contract compliance analysis

Responsibilities:

Essential Job Functions

1. Analyzes contract performance and tracks reimbursement levels for accuracy as compared to the applicable contract agreements and payers medical policy language. Reviews payments to ensure a high degree of accuracy and initiates corrective action with third party payers, as necessary.

2. Assists other Contract Compliance Analyst and Payor Relations personnel in the review and preparation of information concerning payer performance. Provide input on the performance of payer contracts along with recommendations for contract changes to improve performance.

3. Analyzes and researches contractual and reimbursement issues and answers inquiries posed by Health System and third party payer personnel.

4. Pursues identified reimbursement underpayments. Maintains a follow up and reporting system to ensure receipt of reimbursement as well as determining the level of reimbursement recovery.

5. Uses computer system to produce reports as requested in a timely and accurate manner. Work should be completed by the due dates specified in the assignment.

6. Assists in the development and maintenance of computer reports and logs to answer inquiries concerning contract and payor performance.

7. Provide training concerning contracts and reimbursement to the cashiering area and other areas of the Health System as requested by the Department Manager.

Schedule:

8am to 4:30pm

Job Description:

Job Requirements

Education

• High School Diploma or General Educational Development (G.E.D.) required.

Experience

• A minimum of 2-3 years experience working for a 3rd party payor or health care provider is preferred.
• Six months previous Professional billing experience preferred. ICD and CPT coding preferred.
• Requires the ability to operate a 10-key calculator by touch and entry of data with accuracy.
• Knowledge and some experience in the use of Word, Excel and Access as well as the ability to learn new software programs is required.
• Past experience in insurance claims and/or managed care contracting helpful.

License/Certifications

• N/A

Skills/Knowledge/Abilities

• Participates in mandatory in services and continuing education programs as mandated by policies and procedures/external agencies and as directed by supervisor.
• Requires ability to understand basic accounting and math principles, to communicate at a level normally acquired by completion of college, including two semesters of bookkeeping or one semester of college accounting.
• Requires the ability to communicate effectively with patients, employees and 3rd party payers.
• Research Professional claims to determine correct contract reimbursement using many PPO contracts.
• Basic working knowledge of CMS.
• Requires the ability to operate a 10-key calculator by touch and entry of data with accuracy.

Physical Requirements

Weight Demands

• Light Work - Exerting up to 20 pounds of force.

Physical Activity

• Occasionally Performed (1%-33%):
  • Balancing
  • Climbing
  • Carrying
  • Crawling
  • Crouching
  • Distinguish colors
  • Kneeling
  • Lifting
  • Pulling/Pushing
  • Reaching
  • Standing
  • Stooping/bending
  • Twisting
  • Walking
• Frequently Performed (34%-66%):
  • Hearing
  • Repetitive Motions
  • Seeing/Visual
  • Speaking/talking
• Constantly Performed (67%-100%):
  • Fingering/Touching
  • Grasping
  • Keyboarding/typing
  • Sitting

Job Hazards

• Not Related:
  • Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)
  • Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
  • Equipment/Machinery/Tools
  • Explosives (pressurized gas)
  • Electrical Shock/Static
  • Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
  • Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
• Rare (1-33%):
  • Chemical agents (Toxic, Corrosive, Flammable, Latex)
  • Mechanical moving parts/vibrations

About Methodist:

Nebraska Methodist Health System is made up of four hospitals in Nebraska and southwest Iowa, more than 30 clinic locations, a nursing and allied health college, and a medical supply distributorship and central laundry facility. From the day Methodist Hospital was chartered in 1891, service to our communities has been a top priority. Financial assistance, health education, outreach to our diverse communities and populations, and other community benefit activities have always been central to our mission.

Nebraska Methodist Health System is an Affirmative Action/Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation, gender identity, or any other classification protected by Federal, state or local law.

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About Us

At Methodist Health System, we focus on providing exceptional care to the communities we serve and the people we employ.

We call it TheMeaning of Care– a culture that has and will continue to set us apart. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s needs, or giving a high five when a patient beats a disease or conquers a personal health challenge.

If you join our organization, you will have the opportunity to excel in your field, use the latest technologies, learn from the best and work as a team. You’ll have the opportunity to make a difference throughThe Meaning of Care.