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Role Description
The Analyst I is a subject matter expert responsible for the maximization of insurance reimbursement by identifying contractual variances between posted payments and expected reimbursement for managed care, government payors, and other payors as needed. Responsibilities include:
• Contractual reimbursement analysis and communication of payment discrepancies to both internal and external departments.
• Identifying trends in underpayments and determining effective paths to resolution.
• Analyzing and interpreting contract reimbursement and providing feedback to leadership as required.
• Reviewing large amounts of remittance data to locate charge or billing opportunities for revenue optimization.
Essential Job Functions:
• Communicate directly with payors to follow up on outstanding underpayments, file underpayment appeals, resolve account variance, and ensure timely recovery of underpayments.
• Identify root causes of underpayments, denials, and delayed payments to clients.
• Maintain a thorough understanding of applicable state and federal insurance regulations as well as payor specific requirements.
• Document all activity accurately in the client’s host system or other appropriate tracking system.
• Demonstrate initiative and resourcefulness by making recommendations and communicating trends to management.
• Operate as a strong problem solver and critical thinker to resolve underpayments.
• Meet all productivity and quality standards as established by Ensemble and Revenue Recovery leadership.
• Compile and analyze data to identify underpayments and report findings to leadership.
• Work collaboratively with other departments, including Managed Care, Billing, Coding, Revenue Integrity, and Payor Strategy.
• Work multiple projects, reports, and tasks efficiently in a fast-paced, KPI-driven atmosphere autonomously.
Qualifications
• Minimum five (5) years of experience in the hospital or physician insurance industry, or elsewhere in the revenue cycle.
• Proven understanding of the revenue cycle and identification of underpaid accounts.
• Bachelor’s degree preferred, but not required; high school diploma or GED required.
Requirements
• Excellent verbal and written communication skills.
• Professional presence.
• Exceptional customer service.
• Ability to adapt to multiple client host systems.
• Integrity and honesty.
• Internal drive to succeed.
• Experience with Microsoft Office suite of programs.
Benefits
• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement