Healthcare Reimbursement Analyst (Job ID #147372)

Provide case management services to patients/families.

• Interview patient to obtain demographic and social data as related to financial status, income, and access to community and/or medication resources. 
• Provide general information regarding community and other government agencies. In addition, facilitate applications for programs including, but not limited to, Medicare, Medicaid (Public Aid), Circuit Breaker, Senior Care, and Ryan White.
• Screen patients/families in consultation/supervision with MSW Supervisor regarding patient/family ability to use community services.
• Teach patient/families how to work efficiently with community and UICMC systems.
• Develop and present educational seminars for staff and DHSW staff regarding available community resources.
• Provide assistance with IDPA 2636, Allkids, MANG/disability, Emergent Need, SA Vouchers, CVC applications, ABE, SNAP or any financial entitlement program to patient/families when deemed necessary.
• Provide assistance and completion of Birth Certificates and the processing of all forms and submission to the State of Illinois.
• Follow up with patients to determine status of coverage through state and Federal entitlements and manufacturer programs.

Provide exploration and updating of community resources and procedures, and the dissemination of this information to the Health Social Work Staff.

• Updating eligibility for community resources.
• Exploring services of new community agencies (i.e., target population, eligibility for services, patient cost, length of services, etc.)
• Establishing and maintaining a resource file which would be available to other departmental staff.
• As assigned, participates in social work and patient account meetings.
• Assists in the analysis and interpretation of rules and regulations as they apply to the health care facility and ensures the data is in the format required for reporting purpose.
• Complies and keeps up to date the Commerce Clearing House on Medicare and Medicaid, CAC, ABE guides and ensures that staff and management are kept abreast of new developments.
• Assists in the examination and analysis of new regulations to determine the financial impact on the health care facility.

Participate in the departmental Continuous Quality Improvement program. Document clinic outcome data and assist in preparing program activity reports.

Assists in assembling data as required during audits.

Function as a clerical support person to other Health Social Work Staff as needed.

Upgrades to all appropriate encounters for patients whom applications are were (Self Pay to Approved Insurance).

Generate unofficial bills for purpose of Financial applications or when SW/UM staff request to submit on a letter of financial responsibility.

Process Community Discount upon request with collaboration from Patient Accounts.

Assist with Redetermination applications.

Maintain appropriate and required records, such as documentation in EMR and monthly departmental statistics.

Using a knowledge of Medicare and Medicaid government regulations, completes statistical and financial modeling to produce cost reports to ensure all possible reimbursement enhancements or opportunities are captured

Completes analysis of new developments and/or proposals in the reimbursement field to determine the financial impact on the health care facility

Gathers data and completes required analysis at the request of outside audit staff during audits by Medicare, Medicaid, and Blue Cross and reports the impact of audit adjustments to management

Assists management in the analysis and development of third party contractual allowances, using financial and statistical modeling

Assists management in the analysis and development of bad debt projections, using financial modeling, for budget forecasting

Assists more senior staff members in the review of existing operating procedures and makes recommendations for the development of settlement data to maximize reimbursement from third party payers

Recommends improvements and modifications to departmental operating procedures to maximize operating efficiency and reimbursement

Completes review and analysis of prior years’ outstanding cost reports to resolve outstanding issues in conformance with regulations and within the time frame imposed by the federal government’s statute of limitations

Provides assistance, by reviewing current and prior years’ data and other necessary variance explanations, in coordinating the annual financial audit of the health care facility by outside audit firms.

Attends Revenue or Financial Entitlement Committee meetings, conferences, Insurance verification webinar/seminars as instructed and other planning/organizational meetings as requested.

Participates in quality improvement initiatives and assists the Director in collecting data regarding quality measures

Completes financial modeling to ensure all possible reimbursement enhancement opportunities are captured.

Assists in the examination and analysis of new regulations to determine the financial impact on the health care Facility

Advises underinsured patients to take corrective actions to enhance their insurance coverage

Collaborates with other departments to provide documentation necessary for optimizing reimbursement

Pursues Certified Application Counselor (CAC) status when meeting criteria

Performs other related duties as assigned