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Job Summary

Company
Columbia United Providers
Location
Vancouver, WA 98683
Industries
Healthcare Services
Job Type
Full Time
Employee
Years of Experience
2+ to 5 Years
Education Level
High School or equivalent
Career Level
Experienced (Non-Manager)

Reimbursement Analyst

About the Job

Columbia United Providers is a regional health plan located in Vancouver, WA.  We are currently recruiting for a Reimbursement Analyst to work in our Information Systems Department.  The Reimbursement Analyst is responsible for implementing and maintaining provider/facility contracts and fee schedules in the IDX system, ensuring that claims get paid according to the contractual agreements.


 


RESPONSIBILITIES:




  • Interprets and implements provider and facility contracts into the GE/IDX system; setting up the exceptions and rates according to the contract.



  • Responsible for building fee schedules based on the payment methodology stated in the contract, using MAA, CMS and other base payment rates.



  • Analyze different reimbursement methodologies, including OPPS, DRG’s, Per Diems, RVU’s, and RBRVS.



  • Reviews any contract changes made throughout the year and make recommendations to the Reimbursement Supervisor.



  • Maintain and update fee schedule files for all lines of business in a shared directory for easy access to all CUP departments



  • Runs Access and GE/ IDX queries.    



  • Identify exceptions to contract rate reimbursements that directly affect GE/ IDX fee schedules



  • Upload fee schedule edits and or corrections



  • Auditing the fee schedule and contracts for accuracy



  • Work with Provider Contracting on rate reimbursements and provider contract implementation in regards to GE/IDX fee schedules



  • Maintain documentation for fee schedule maintenance and contract set up



  • Maintain GE/IDX Dictionaries.



  • Maintain D471 Tracker and Claims Issue Tracker



  • Work dedicated Claims Queues from CQM



  • Resolve provider claims and contract inquiries



  • Train new Reimbursement Analysts



  • Acts as Liaison between Provider Relations and Claims for dictionary updates



  • Prepare and maintain all training documents pertaining to Reimbursement duties.



  • GE/IDX Managed Care application support



  • Other ancillary duties as assigned that apply to this position

  • REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES:


    Knowledge of GE/IDX MCA application,


    Excellent organization, prioritization & communication skills,


    Microsoft Office experience with superior command of Excel and Access 2007


    CPT and ICD-9 coding experience


     


    PREFERRED QUALIFICATIONS:


    Managed Care experience


    Certified Coder


    Extensive knowledge of regulatory coding


    Claim processing experience desirable


    Medicaid and Medicare Billing Guidelines


     


    EDUCATION AND EXPERIENCE :


    HS graduate with 3-5 year job related education (experience may be substituted for education)


    3-5 additional years of experience in a healthcare environment


    Superior command of Excel and Access 2007


     


    We offer a superb compensation package including competitive salary, full range of health insurance options, disability insurance, 401K with match, and annual leave and extended illness banks.

    To apply for this position, please email your cover letter, resume, and contact information to the email address listed above. Only qualified candidates will be considered. Due to the large volume of resumes received, we are unable to verify receipt of your resume and cover letter.  This company is an Equal Opportunity Employer.

     
     

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    Contact Information

    Columbia United Providers