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Reimbursement Analyst

Job ID: 5143
Location: Chapel Hill, NC
Facility/Division: UNC Faculty Physicians
Status: Full Time
Shift: Day Job

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Job Description


Become part of an inclusive organization with over 30,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

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.

1. Verifies all new referrals, re-verifies insurance annually and whenever patients make coverage changes. Assesses accuracy of billing and conducts reimbursement audits. Recommends and assists in implementing corrective actions resulting from reviews.
2. Assists in determining patient's financial ability to pay for Hemophilia therapies based upon their income, insurance benefits and available resources.
3. Ensures that all reconciled items and past due balances are resolved to completion through contact and follow-up with payers/patients.
4. Assists with prior authorizations, Letters of Agreement (LOA) to ensure they are in place and up to date.
5. 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.
6. Educates physicians, pharmacists 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.
7. 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.
8. Prepares analyses of department fee schedules and makes recommendation 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.

9. 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 claim refiles.

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

11. 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.

12. Serves as a resource to the patient on financial matters and insurance questions.

13. Cross-trains with members of the specialty pharmacy reimbursement team to be proficient in the submission of claims (major medical and pharmacy) posting of payments and appeals. Serves as a resource for the pharmacy reimbursement team by training, assessing and supporting the scope of reimbursement activities.

Other Information

Other information:
Education Requirements:
● Bachelor’s degree in an appropriate discipline (or equivalent combination of education, training and experience).
Licensure/Certification Requirements:
● No licensure or certification required.
Professional Experience Requirements:
● If a Bachelor's degree: No experience required.
● If an Associate's degree: Four (4) years of experience in business analysis and planning, accounting, finance, health care administration or data base management/analysis.
● If a High School diploma or GED: Eight (8) years of experience in business analysis and planning, accounting, finance, health care administration or data base management/analysis.
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

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.
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Diversity Statement

The UNC Health System and the UNC School of Medicine are committed to valuing all people throughout our organization, regardless of background, lifestyle, and culture. A diverse and inclusive work environment for staff and culturally appropriate care for our patients, are essential to fulfilling our UNC Health vision of improving the health of all North Carolinians.

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