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Memorial Healthcare System · 21 hours ago

Managed Care Revenue Optimization Analyst - FT - Days - MSS - Hybrid Eligible

Miramar, FL

Full-time

Hybrid

Entry, Mid Level

2+ years exp

Memorial Healthcare System is dedicated to improving health and quality of life for the community. They are seeking a Managed Care Revenue Optimization Analyst to review and analyze denials and short payments from insurance plans, taking necessary actions to obtain payments in accordance with billing guidelines and laws.

Health Care

Responsibilities

Responsible to meet and maintain production and quality standards defined by department policies and procedures

Reviews and analyzes managed care balances related to short payments, denials or those aged with no response. Evaluates the authorization, coding, billing and correspondence to identify underlying issue and determine best course of action to be taken to collect. Compiles detailed written appeal document outlining position for payment

Tracks outcomes of requests for payment to ensure timely identification of additional actions needed. Reconciles and updates business system and reports with findings and formalizes appeal documents required for follow up action

Interacts directly with Department Clinical Team as needed to obtain pertinent clinical facts needed to support medical necessity of services provided

Creates and maintains spreadsheets of open accounts. Works directly with plan contacts to exchange data, identify root causes of issues and reconcile data to confirm resolution

Responsible for identifying and reporting to Management payment and denial trends for assigned payors