Company Mission:
To be the best provider of comprehensive and innovative clinical laboratory services for the prevention, diagnosis and treatment of complex chronic disease.
Company Vision:
The Genova Diagnostics team will improve the lives and well-being of patients by bringing insights to the complexity of health.
Position Summary:
The Billing and Reimbursement Analyst is responsible for analyzing claim level data to ensure that billing processes, practices, and procedures result in appropriate reimbursement in an effective and efficient manner. Monitors and reports third party payer billing performance to Management. He/she identifies opportunities for reducing third party A/R and improving reimbursement; and works internally across the ARBO team and externally with third party payers and billing vendors to leverage these opportunities to improve billing performance.
Investigates and resolves key reimbursement issues. This position manages key aspects of the third party A/R to ensure appropriate financial and billing performance. He/ she supports the ARBO Leadership team in achieving excellent billing and reimbursement performance.
Essential Duties and Responsibilities:
Responsibilities include but are not limited to the following:
Technical
- Analyzes claim level aging, denial, and payment information to identify trends and potential opportunities for improved reimbursement performance.
- Use of aging reports of open claims to identify key reimbursement and A/R reduction opportunities
- Use of denial information from adjudicated claims to target key billing and reimbursement issues.
- EOB review to ensure that denial and payment data is captured and reported correctly.
- Supports and undertakes the development of consistent and efficient billing and denial processes that result in improved reimbursement.
- Development of SOPs at the payer and denial level.
- Development of appeal processes consistent with payer requirements and based on opportunity for payments.
- Coordinates third party billing processes between key constituencies to achieve consistent billing performance.
- Develops tools that can be used across departments to support consistent billing practices.
- Works effectively with ARBO Supervisors on standardizing third party billing practices.
- Researches third party billing issues and questions to ensure that billing practices are current and appropriate.
- Responsible for developing metrics and scorecards for the measurement of third party payer billing and reimbursement performance trends.
- Regularly publishes scorecards, key issues, and status updates to Director of Reimbursement
- Develop systematic approaches for billing third party payers in order to ensure appropriate claims processing.
- Responsible for maintaining payer details and for managing set up process for new payers
- Maintains full awareness of compliance issues in relation to any insurance contracts, and other insurance regulatory issues. Must report any concerns with applicable government regulation, compliance issues to the Office of Quality.
- Produces data essential for the financial review of third party payers and accounts receivable. Works with Director of Reimbursement and Finance team to set write off and reserve criteria for A/R.
- Researches regulatory directives and mandates, and assists with the implementation of billing practices to meet these requirements, especially as it pertains to Government Payers.
Other
- Identifies special projects to reduce A/R and generate incremental cash.
- Works with local IT and with software vendor through TMS system to research system settings and capabilities to implement correct and appropriate systematic billing and reimbursement processes.
- Other duties as determined by the Director of Reimbursement or required to meet goals and objectives.
- Works extensively with the AR Leadership Team and with all departments in ARBO to ensure consistent billing performance. Frequent contact with Financial Analysts and Accounting as well as other operational departments within the organization. External contact with insurance companies, Government payers, IPAs, re-pricing organizations, TPAs, A/R system vendor, and clearinghouse. Also may contact physician’s offices and patients.
Supervisory Responsibilities:
This job has no direct supervisory responsibilities but serves on the Accounts Receivable Leadership Team.
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Candidates must have the following skills and attributes: detail oriented type of individual with good organization skills; understanding of claims processing, outpatient healthcare billing, and healthcare reimbursement from the provider or insurer perspective; strong analytical skills and an ability to act intuitively based on a review of relevant data; process oriented problem solver; high level of desire for professionalism, quality and achievement; strong personnel leadership skills with managerial potential; ability to successfully manage multiple tasks and projects, along with competing priorities; ethical and mature in nature and personality; strong verbal and written skills allowing for professional communication to all levels of management; and positive attitude.
The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience:
This position requires a high school education; Associate’s degree or some college preferred. Candidates must have 3 years minimum experience in a health care business office environment with a background in insurance billing, claims processing, Government payers, and denial management.
Computer Skills:
To perform this job successfully candidates should have strong computer aptitude, including all standard Microsoft Office products, especially Excel. Access experience preferred.
