(100% remote, corporate headquarters in orange, ca)
As an established management services organization (mso) with over 30 years of experience in the business of healthcareMsm is developing the next generation software platform to enable health systems and physicians to maximize their effectiveness in the areas revenue cycle management, data processing, system integration, data visualization, analytics, and practice managementWe are on a mission to reinvent the healthcare back-office with cutting edge technology and design.
About the role
The reimbursement contracts analyst is responsible for the accuracy of our client’s expected reimbursement calculations in their patient accounting system and will act as a subject matter expert regarding contract interpretation, variance reporting and reimbursement analysisThis role will develop and maintain variance reports and performs analysis of payment variances from insurance payersThe analyst would provide ongoing maintenance to managed care contract terms within the patient accounting system and all other related information systemsThis role would stay current on insurance industry practices and governmental rules to make informed decisions about changes in reimbursement rates.
What you’ll do
Serve as a subject matter expert for expected reimbursement Coordinates the maintenance and updates of client’s contracts module within their patient accounting system to ensure accuracy in expected reimbursement Function as a liaison between revenue cycle operations, finance, contracting and information technology Review of new contract build thorough testing of contract based on rate structure and risk areas before contract is pushed to production environment Performs reimbursement audits regularly to determine accuracy in expected reimbursement and to ensure contract complianceClearly documents associated findings in a timely and accurate mannerIf payment variances are discovered work with client to resolve issue (e.g., inaccurate patient accounting system calculation, remit code issue or contract interpretation discrepancy) Not only identifies payment variances resulting from calculation errors, but also solutions and work with the client until issue is fully resolved Research and resolve inquiries and concerns from client that may be related to contract management issues, such as recurring payment discrepancies, denied charges, etc. Maintains up-to-date knowledge of current and emerging information regarding client’s payer contracts, medicare legislation, regulations, market activity and industry trendsUnderstands how changes, especially surrounding cms coding changes can impact reimbursementResponsible for updating qualifiers for contract terms to comply with cms coding changes Researches and analyzes issues using tools such as the internet, medicare bulletins, cms web site and coding guides Other duties as assigned
What you’ll need
Degree required (e.g., associate, bachelors, masters) Minimum of 4+ years healthcare experience within hospital revenue cycle environment 2 - 3 years of experience data mining, trending, and auditing claims with accuracy 2 - 3 years of experience working in a patient accounting system (e.g., epic, cerner, meditech, etc.) Understanding and knowledge of medical terminology, claims billing, and inpatient and outpatient coding (e.g., msdrg, icd-10 diagnosis and procedure codes, cpt, hcpcs, etc.) Experience and knowledge with inpatient and outpatient reimbursement methodologies as well as a deep understanding of managed care contracts (e.g., case rates, per visit, fee schedules, ambulatory surgery groupers, multiple procedure discounts, apc, exclusions, outpatient hierarchy) Understanding of hospital revenue cycle Strong mathematical knowledge as it relates to calculating expected reimbursement Strong analytical capabilities required with demonstrated organizational and problem-solving ability Attention to detail and capability to apply discretion and sound judgment in managing complex processes, decisions and handling sensitive information Highly motivated, organized, exceptional communication (written and verbal), excellent time management and exhibit professionalism at all times Demonstrates a strong ability to build partnerships and influence othersWork across team, group, and business boundaries to drive commonality and reusability in solution to real-world problems Ability to relate well to all kinds of people, up, down, and sideways, inside and outside the organization Ability to work independently with minimal supervision and collaboratively as part of a team Proficiency with excel, word, powerpoint
Awarded the orange county register’s top workplace 11 years running Competitive salary 100% company paid medical and dental coverage for select plans Company sponsored retirement plan Pto and company paid holidays Awesome workplace culture Volunteer and philanthropic opportunities
About medical specialties managers (“msm”)
At medical specialties managers, inc., we believe that a company is only as strong as the people it employsWe have a casual, enthusiastic, dynamic and collaborative working environmentWe are a “flat” organization with an open-door policyWe are continuously focused on creating a positive and cooperative atmosphereWe strongly believe that practicing mutual respect in our relationships is beneficial for employees and employers alikeWe make efforts to support our staff in achieving their personal and career goalsTo that idea, we believe promoting from within creates a foundation of employees that are motivated, dedicated and highly knowledgeableProviding our employees with an outstanding work environment, competitive compensation, bonus plan and an exceptional benefits package has resulted in being awarded “the orange county register’s top workplaces” honor for 11 years runningWe have few positions in office, but the majority of our employees are working remotelyOur corporate office is located in orange, caIt is our hope that being employed at msm is both challenging and rewardingWe have a passion for what we do, and we want our employees to feel the same.
Providence stJoseph health
In january 2017, the company was acquired by providence stJoseph healthThe future of the organization is bright as msm is the exclusive practice management and revenue cycle management provider to medical group practices associated with providence stJoseph healthProvidence stJoseph health is a leading healthcare organization created by the merger of providence health & services and stJoseph health with the goal of improving the health of the communities it serves, especially those who are poor and vulnerableThe organization has over 100,000 caregivers serving over 50 hospitals, 800 clinics, and a comprehensive range of services across alaska, california, montana, new mexico, oregon, texas, and washington.