Reimbursement Analyst

Description

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

Summary :

Performs a variety of operational and financial analyses and reporting in order to maximize the collection of all billable charges. Employees work independently under the direction of an administrative superior and may serve as a project team coordinator or leader, working with staff from various levels of operation to resolve a particular issue. Employees work closely with clinical managers and staff to improve revenue flow.

The position will be a hybrid role - on-site Monday through Thursday at our Chapel Hill Quadrangle location, and remote on Fridays. We're a small but mighty 340B HTC specialty pharmacy serving about 300 patients with bleeding disorders throughout the State of North Carolina. The position will handle billing of these medications to our patients' health plans from the start of referral to payor reimbursement back into our system; this includes benefits investigations, daily claim filing (both pharmacy and medical), auditing, and accounts receivable.

Responsibilities :

1. Assesses accuracy of billing and conducts reimbursement audits. Recommends, and assists in implementing corrective actions resulting from reviews.

2. Assists in designing specific procedures and systems changes. Coordinates with external organizations (including drug manufacturers and insurance carriers) on projects and issues to maximize reimbursement.

3. Educates physicians and other clinic and administrative staff on concepts, issues and processes related to reimbursement. Prepares communications and training materials. Drafts technical documentation such as user guides for reimbursement systems and procedures.

4. Monitors and analyzes a variety of data from internal and external sources to identify trends in reimbursement denials. Develops and execute reports which aid in analysis of financial data to determine root causes of problems. Charts and tracks revenue-related changes (e.g., charges, receipts, third party sponsorship, collection rates) over time.

5. Prepares analyses of department fee schedules and makes recommendations for changes, considering new or changed CPT codes and other relevant information. Produces impact projections to assess the viability of any proposed changes to fee structures.

6. Prepares appeals of third party decisions. Conducts background research collects data assembles documentation and follows up with agency to obtain decisions. Serves as liaison and manages records and files of such appeals. Directs mass claim refiles,

7. Recommends changes to processes and other revenue structures. Recommends additional opportunities for increased revenue based on analyses.

8. Serves on cross-departmental project teams to design, plan and implement changes in the operational processes and programming to enhance current processes and develop more efficient processes. Serves as special projects coordinator in systematic problem resolution.

Other Information

Education Requirements :

• Bachelor's degree in an appropriate discipline (or equivalent combination of education, training and experience).

Licensure / Certification Requirements :

Professional Experience Requirements :

Knowledge / Skills / and Abilities Requirements :

Job Details

Legal Employer : STATE

Entity : UNC Faculty Physicians

Organization Unit : Hemophilia Treatment Center

Work Type : Full Time

Standard Hours Per Week : 40.00

Salary Range : $23.01 - $33.07 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type : Hybrid

Work Schedule : Day Job

Location of Job : US : NC : Chapel Hill

Exempt From Overtime : Exempt : Yes

This is a State position employed by UNC Health Care System with UNC Health benefits. If, however, you are presently an employee of another North Carolina agency and currently participate in TSERS or the ORP, you will be eligible to continue participating in those plans at UNC Health.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and / or to apply for a career opportunity.