Brown University Health
Overview
Summary:
Under the general direction of the Director Contracting Analytics and Modeling, perform all duties necessary to properly identify and process recovery of revenue for Contract Management and Managed Care denials for Brown University Health and its Rhode Island affiliates. Take appropriate steps to identify, review and reduce Managed Care denials of coverage. Audit Managed Care actual payments against contracted payments and initiate adjustment process to recover any identified underpayments. Brown University Health employees are expected to role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences, Patient and Community Focus and Collaborate.
Responsibilities
In conjunction with the Brown University Health Patient Financial Services Department, identify and coordinate all efforts to recover Managed Care underpayments.
Assist to implement and monitor compliance of Managed Care contract reimbursement.
Report non-compliance and payer issues to the Director of Contracting.
Assist the Director of Contracting in compiling any necessary statistics needed for contract management and follow-up activities.
Ensure timely and accurate processing of adjustments and denials from payers. Initiates action to resolve accounts.
Meet with Managed Care payers, Contracting and PFS follow-up staff as necessary to resolve disputes related to accounts receivable and to discuss changes in contracts.
Identify and initiate corrective measures and rebilling of improper denials and underpayments by Managed Care contractors.
Process all necessary online adjustments or changes as needed, such as adding/deleting insurance information, insurance priority changes, balance transfers, demographic changes, contractual allowances, any other routine patient accounting adjustment not requiring supervisory approval.
Continually evaluate workflow and identify opportunities to improve processes and full and complete payment for hospital services.
Analyze financial and contractual data used in determining reimbursement compliance. Compile, review, adjust and monitor any variances. Ensure accuracy, efficiency and integrity of all information systems pertaining to Managed Care denials and reimbursement.
Participate in staff meetings, councils, quality improvement teams and other such meetings and committees as required.
Develop and maintain working relationships with Brown University Health affiliate departments as needed to ensure full data exchange.
Troubleshoot existing and/or potential problems in the claims processing process and contract management modeling system, recommending changes as appropriate.
Maintain quality assurance, safety, environmental, and infection control in accordance with established policies, procedures and objectives of the system and affiliates.
Perform other related duties as required.
Qualifications
Minimum qualifications
Bachelor’s Degree in health services administration, finance or related field or the equivalent experience.
Comprehensive knowledge of patient accounting activities in an automated, networked, multiple hospital environment.
Detailed knowledge of reimbursement schemes for predominant payers.
Detailed knowledge of regulatory requirements.
Experience
Three years’ experience in patient accounting.
Ability to make sound interpretation of Managed Care contract language.
Ability to perform financial analysis.
Independent action: Functions independently within Brown University Health and Department policies.
Supervisory responsibility: None.
Pay and Location Base pay range:
$23.81/hr - $39.28/hr
Location:
Corporate Headquarters - 167 Point Street Providence, Rhode Island 02903
Work Details
Work Type:
Monday-Friday, remote
Work Shift:
Day
Daily Hours:
8 hours
Driving Required:
No
EEO Statement Brown University Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran, or marital status. Brown University Health is a VEVRAA Federal Contractor.
Other County: Providence, RI
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Summary:
Under the general direction of the Director Contracting Analytics and Modeling, perform all duties necessary to properly identify and process recovery of revenue for Contract Management and Managed Care denials for Brown University Health and its Rhode Island affiliates. Take appropriate steps to identify, review and reduce Managed Care denials of coverage. Audit Managed Care actual payments against contracted payments and initiate adjustment process to recover any identified underpayments. Brown University Health employees are expected to role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences, Patient and Community Focus and Collaborate.
Responsibilities
In conjunction with the Brown University Health Patient Financial Services Department, identify and coordinate all efforts to recover Managed Care underpayments.
Assist to implement and monitor compliance of Managed Care contract reimbursement.
Report non-compliance and payer issues to the Director of Contracting.
Assist the Director of Contracting in compiling any necessary statistics needed for contract management and follow-up activities.
Ensure timely and accurate processing of adjustments and denials from payers. Initiates action to resolve accounts.
Meet with Managed Care payers, Contracting and PFS follow-up staff as necessary to resolve disputes related to accounts receivable and to discuss changes in contracts.
Identify and initiate corrective measures and rebilling of improper denials and underpayments by Managed Care contractors.
Process all necessary online adjustments or changes as needed, such as adding/deleting insurance information, insurance priority changes, balance transfers, demographic changes, contractual allowances, any other routine patient accounting adjustment not requiring supervisory approval.
Continually evaluate workflow and identify opportunities to improve processes and full and complete payment for hospital services.
Analyze financial and contractual data used in determining reimbursement compliance. Compile, review, adjust and monitor any variances. Ensure accuracy, efficiency and integrity of all information systems pertaining to Managed Care denials and reimbursement.
Participate in staff meetings, councils, quality improvement teams and other such meetings and committees as required.
Develop and maintain working relationships with Brown University Health affiliate departments as needed to ensure full data exchange.
Troubleshoot existing and/or potential problems in the claims processing process and contract management modeling system, recommending changes as appropriate.
Maintain quality assurance, safety, environmental, and infection control in accordance with established policies, procedures and objectives of the system and affiliates.
Perform other related duties as required.
Qualifications
Minimum qualifications
Bachelor’s Degree in health services administration, finance or related field or the equivalent experience.
Comprehensive knowledge of patient accounting activities in an automated, networked, multiple hospital environment.
Detailed knowledge of reimbursement schemes for predominant payers.
Detailed knowledge of regulatory requirements.
Experience
Three years’ experience in patient accounting.
Ability to make sound interpretation of Managed Care contract language.
Ability to perform financial analysis.
Independent action: Functions independently within Brown University Health and Department policies.
Supervisory responsibility: None.
Pay and Location Base pay range:
$23.81/hr - $39.28/hr
Location:
Corporate Headquarters - 167 Point Street Providence, Rhode Island 02903
Work Details
Work Type:
Monday-Friday, remote
Work Shift:
Day
Daily Hours:
8 hours
Driving Required:
No
EEO Statement Brown University Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran, or marital status. Brown University Health is a VEVRAA Federal Contractor.
Other County: Providence, RI
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr