The Payment Validation Analyst works under the supervision of the Director of
Revenue Integrity. Responsible for ensuring accurate payment is received from
payors, including line level payment validation where appropriate.
RESPONSIBILITIES
Remote States: Candidates residing in the following states will be considered
for remote employment: Alabama, Colorado, Florida, Georgia, Idaho, Indiana,
Iowa, Kansas, Kentucky, Minnesota, Missouri, Mississippi, Nebraska, North
Carolina, Oklahoma, Texas, Utah, and Virginia. Remote work will not be permitted
from any other state at this time.
Responsible for analyzing contractual underpayments. Identify and resolve
daily encounters holding in Epic WQs for contractual underpayments. Identify
root cause and work on corrective action implementation.
Responsible for resolving encounters in Epic WQ for price/contract
discrepancy. Identify root cause and work with CDM Analyst/Revenue Integrity
Analyst to implement fee schedule correction, and/or identify root cause
causing the discrepancy.
Works on rebill projects focused on recoupment of underpayments.
Subject matter expert regarding payer reimbursements and contracts. Be
informed of changes to payer reimbursement and work with CDM Analyst and/or
Revenue Integrity Analysts to implement changes, if and as needed.
Research non-covered and/ or denied charges to identify root causes. Works
with the Revenue Integrity Manager to assist with appeals.
Identifies Coding, Charging, and/ or Billing issues/ patterns that are
resulting in inaccurate payment and works with/ educates the appropriate
staff to resolve them. Monitors and tracks accounts that have been identified
for re-billing to ensure proper payment is ultimately received.
Utilize Epic reports to prepare monthly measurement reports regarding any/
all findings, follow-up actions taken, and any recommendations that need
DIRECTOR or above approval.
Creates and maintains contracts in Epic.
Assists with the start-up process for new programs. Helps to identify
services that are reimbursable but are not being coded or charged for.
Research and resolves CPT code, revenue code and other charge master related
issues referred by the Patient Financial Services, Coding, or Revenue
Integrity departments.
Coordinates routine individual projects by planning and organizing project
steps.
Utilizes logical sequential steps and understands flowchart techniques with
minimal direction when working on projects.
Other duties as assigned
Education
Bachelor's Degree - Required
H.S. Diploma - Required
Work Experience
5 Years - Health care experience. Minimum five years' experience and
knowledge of hospital financial operations including reimbursement, Medical
Billing, Charge Master Development and Maintenance, Medical Records/Coding
and Charge Audit experience. - Required
5 Years - Broad based knowledge of hospital financial operations including
reimbursement, coding and charge master development and maintenance. -
Required
5 Years - In-depth knowledge of CPTs, HCPCs and ICD-10 medical coding, and
related APC Medicare reimbursement. - Required
Licenses and Certifications
Epic Certifications - Epic Contracts Module Certification - Preferred Upon
Hire
Travel Requirements
Travel to off-site locations may be required. - Required
QUALIFICATIONS
Skills and Abilities
Essential Technical/Motor Skills
Input data, type, manipulate calculator and small business equipment, speak
clearly and professionally, answer telephone, copying.
Interpersonal Skills
Oral and written communication skills with staff, leadership, physicians and
consultants on an individual basis as well as interaction on teams.
Essential Physical Requirements
Lifting, moving, reaching, bending, stooping, standing, walking, typing,
operating small business equipment.
Essential Mental Abilities
Analyze, synthesize, evaluate, comprehend, explain, understand, forecast,
interpret, manipulate numbers, interpret data, calculate, organize, plan,
small and large group presentations.
Essential Sensory Requirements
Eyesight, hearing.
Exposure to Hazards
Electrical output of personal computer, eye/neck strain.
Other Skills and Abilities
Must be a highly energetic, motivated self-started.
Must have the ability to determine areas of concern.
Accuracy important 95% of the time.
Confidentiality important 100% of the time.
Mosaic Life Care is a health care system in northwest Missouri. With a vision of
transforming community health by being a life-care innovator, Mosaic places the
holistic needs of patients first by providing the right care at the right time
and place, offering high value and quality health care.
Mosaic has a wide array of benefits to meet each employee’s individual needs.
Our benefits were designed by listening to people just like you. Mosaic also
offers several perks with a focus on ensuring our employees feel valued,
including concierge services, employee lounge, wellness programs, free covered
parking, free on-site and virtual health clinics and many more. When paired with
compensation and recognition, it is what continues to make us the employer of
choice for employees at any stage of their journey.