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Sharp HealthCare · 1 day ago

Reimbursement Analyst - PFS Sharp Foundation Models - Sharp Corporate - Day Shift - Full Time

San Diego, CA

Full-time

Onsite

Senior Level

$36.83/hr - $53.23/hr

5+ years exp

Sharp HealthCare is a prominent healthcare organization seeking a Reimbursement Analyst to provide coding support and appeal guidance related to reimbursement issues. The role involves researching policies and regulations to maximize reimbursement and acting as a liaison between the PFS Business Office and Regulatory Compliance department.

Health CareNon Profit

Responsibilities

To provide coding support and appeal guidance relating to reimbursement issues

Research and propose recommended action on policies and regulations to enable Sharp HealthCare entities to obtain the highest possible reimbursement

To act as a liaison between PFS Business Office Staff and Regulatory Compliance department

Utilize the payer contract tool to report payer trends

Ensures timely coding and reimbursement tools are supplied to physicians, peers and subordinates

This position serves as a resource for staff to have outstanding accounts reviewed for documentation supported by coding reviewed in order to perform timely follow-up collections and claim form submissions

Demonstrates effective customer relations by: Consistently communicate with Executives, Operations Senior Management, department members and other Sharp employees in a pleasant, professional and effective manner

Respond appropriately to needs, preferences and dissatisfactions expressed by customers within a time period appropriate to the request

Maintain confidentiality

Ensure effective, customer-focused operations of responsible areas

Provide effective consultation and support services to Executives, Operation Senior Management, to assist in strategic and operational planning and facilitate achievement of organizational and departmental goals

Assist in analyzing and interpreting trends and variances requiring Manager Business Service and/or Manager of Quality control's attention

Provides effective leadership of the position, including properly motivating peers, ensuring optimum levels of productivity, reengineering workloads, etc

Ensures entity-specific quantitative and qualitative analyses are completed and communicated

Provide educational lectures on regulatory changes to CCD staff when required

Documents and updates system usages related policies and procedures

Reviews System capabilities to ensure user functionality and satisfaction in accordance with corporate goals and objectives

Coordinates and/or assists the medical group in the establishment of correct coding tools for compliant billing and reimbursement

Investigate user problems; perform troubleshooting activities and communicates resolution to the affected parties

Provide coding and reimbursement analysis PFS/CCD and medical group

Responsible for the planning, coordination and accumulation of documentation for the preparation of meaningful, accurate and timely appeals and the quantitative and qualitative analyses and supporting documentation thereto

Responsible for the planning, coordination and accumulation of documentation for reopening items or appeal issues the Manager of the Business Office and or Quality requests

Provide documentation timely and accurately so that the reopenings or appeals meet all filing deadlines

Demonstrates effective customer relations by: Consistent communication with Physicians, Operations Staff, Management, department members and other Sharp employees in a professional and effective manner; responds appropriately and timely to needs, preferences and dissatisfaction expressed by customers

Ensures effective, customer-focused operations; analyzes and evaluates the rejection volume of fee for service reimbursement

Recommend and assist with the implementation of techniques to improve productivity, increase efficiencies, reduce costs, and maintain state of the art practices

Ensure compliance with corporate policies, keep abreast of current trends in healthcare, accept interpersonal differences, respecting others values and opinions and promoting cooperation, effectively prioritizing workload to meet required deadlines and setting goals and objectives in conjunction with the manager

Offer ongoing training and consulting to customers

Participate in all meetings related to coding and compliance