Payor Reimbursement Analyst (RN)

Job Description

Networks Connect Professional Staffing is conducting a search on behalf of our client for a Payor Reimbursement Analyst. This leader will support the financial sustainability of the organization through timely , accurate and thorough research of reimbursement issues related to Medicaid and Commercial payors. Responsible to track, trend and reconcile data and report to the Revenue Cycle. Develop and maintain collaborative relationships with payors, Access, Clinics, Managed Care, Business Operations, Leadership and Legal departments.

Responsibilities/Skills/Knowledge:

• Provide timely, comprehensive and accurate review of authorizations/denials to determine appropriate course of action.
• Provide clear direction to others to resolve authorization/denial issues.
• Provide timely appeals which are based on standardized criteria (Interqual and MCG) and follow appropriate escalation processes.
• Monitor payor response to appeals to ensure timely claim payment or write-off.
• Function as a subject matter expert for CRM, Revenue Cycle and the organization.
• Ability to critically think and apply logic and reasoning to dynamically changing healthcare environment.
• Requires superior verbal communication skills and service excellence approach with internal and external stakeholders.
• Must have strong business writing skills.
• Proficient at keyboarding and facile with Microsoft Office Excel, Access and Power Point.

Qualifications:

• Bachelor’s Degree in Nursing (BSN) Required, Masters preferred
• 5 Years experience with 3 years of Utilization Review

Earnings

N/A

Category

Revenue Cycle