Analyst BCN - PFA Reimbursement & Audit Government Programs - BCN000PI
Analyst BCN - PFA Reimbursement & Audit Government Programs - BCN000PI
DESCRIPTION/RESPONSIBILITIES:
DEPARTMENT SPECIFIC DESCRIPTION:
Responsible for assisting in the analysis, audit, review and monitoring of claim payments for variances.
Research and implement new provider reimbursement fee schedules related to government programs.
CORPORATE ANALYST DESCRIPTION:
* Performs routine monitoring of fee schedule updates and/or policies published on CMS/MDCH websites.
* Provides documentation to support new pricing, new initiatives and detailed design as needed.
* Ensures that claims are appropriately paid and reconciled in adherence with government program protocols.
* Completes statistical audits of claims paid by BCN to ensure payment accuracy in accordance with contractual agreements and protocols.
* Performs user acceptance testing related to government program changes; updates new protocols and ensures contracts are being administered correctly once implemented.
* Assists in audits performed by CMS, OFIR or MDCH; assist in resolving identified claim payment problems identified and work with the adjustment team as needed to resolve disputes.
* Respond and resolve pricing related inquiries from various departments such as Claims and Provider Affairs.
* Other duties may be assigned.
GENERAL QUALIFICATIONS
* Bachelor's Degree in Business Administration, Computer Science, Finance, Accounting or related field required.
* Two (2) years experience with claims payments or investigation required.
* One (1) year experience using diagnosis and procedure coding (e.g. CPT, MUPC, HCPCS, ICD-9) related to hospital and medical claims billing and processing required.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, protected veteran status or status as an individual with a disability.
*LI-AH1