Healthcare Claims Adjudication Specilalist Consultant

posted on October 5, 2018

Job Description

Location: New York, NY

Duration: 9 Months

Responsibilities Include:

  • Develops and prepares variety of automated reports which may include augmentation projections, statistical and financial analysis and narratives.
  • Reviews and recommends improvements for financial management of each billing area.
  • Acts as a resource person for resolution of complex billing situations.

Performs Revenue Cycle Management:

Analyzes and improves the performance of front-end billing operations through development and monitoring of performance criteria related to:

  • Front end patient data acquisition and management;
  • Appointment scheduling, patient registration, insurance verification, data entry, charge and diagnosis assignment and charge capture activities;
  • Front-end billing operations key indicators, including denial trending analyses
  • Error reports, claim processing reports, accounts receivable reports and any pertinent ad hoc reports.
  • Identifies problems in the process flow or organizational structure that impedes financial outcomes, proposes solutions and collaborates with department to implement corrective action
  • Monitors the current monthly revenues and communicates results through variance reports. Reviews financial performance, AR analysis and other reports.
  • Analyzes variances and identifies opportunities for improved results.
  • Oversees managed care contracting and related activities for department/ division.
  • Performs reimbursement management.
  • Analyzes payor reimbursement to ensure proper claims adjudication.
  • Monitors payment denials, reductions and rejections to determine operational or coding problems.
  • Manages write-offs, adjust downs, bad debts and other delinquent accounts.
  • Assists with development of charge documents (superbills, encounter forms, PDA formats), to ensure appropriate selection and reporting of services in compliance with coding protocols, AMA and federal guidelines and HIPAA requirements.
  • Responsible for ensuring key revenue cycle functions, including but not limited to: scheduling, verification of insurance and demographic information, co-pay collection, charge capture and referral management are handled in an accurate and timely manner.
  • Ensures the adequate communication of financial and operational results.
  • Strives to streamline operations and effectively apply new concepts and techniques for positive outcomes.
  • Identifies and implements technology to improve operations.
  • Ensures adequate communication of financial and operational results to staff.
  • Collaborates to optimize billing practices and collection.
  • Keeps abreast of billing, coding and reimbursement related issues as they apply to the division and facilitates staff education in regard to these changes.
  • Structures the flow of data to insure timely and appropriate management of clinical and financial issues
  • Ensures the continual efficient and compliant operational performance of the department/division.
  • Ensures department/division staff adheres to system Corporate Compliance Program, HIPAA regulations and all other regulatory standards.