The Payer Reimbursement Analyst is responsible evaluating payments from all third party payers (government and commercial) to identify underpayments. He/she will use Epic and the Experian underpayment analysis software tool to evaluate payer reimbursement. He/she will be the subject matter and technical expert for the Experian system and serve as the interface between SSM and Experian to ensure comprehensive underpayment analysis is consistently performed.
The Payer Reimbursement Analyst will also serve as a liaison between SSM Health PRO, managed care, and finance staff in all regions to quantify underpayments and conduct necessary follow up with payers to recapture underpayments. He/she will also proactively identify workflow, Epic and Experian enhancements to drive efficiency and effectiveness of all PRO revenue cycle processes.
Serves as subject matter and technical expert in the use of the Experian underpayment analysis software tool. Coordinates and collaborates with Experian personnel and SSM IHT staff to ensure optimal performance of the Experian underpayment tool.
Serves as liaison between SSM Health managed care and Experian. Provides updated contract information to Experian timely to ensure system is regularly updated.
Routinely runs and analyzes reports to identify underpayments and works with payers and SSM managed care representatives to capture underpayments. Escalates payer challenges to senior PRO, managed care, and finance leaders, as necessary.
Communicates contract issues and opportunities to PRO, managed care, and finance leaders to ensure payer deficiencies can be addressed via contract negotiation. Participate in such negotiations or other payer meetings as requested.
Immediately notifies Fee Analyst/Pricing Coordinator of any reimbursements at "the lower of" to ensure the SSM fee schedules are promptly updated to ensure full capture of contracted reimbursement rates.
Is watchful for special billing issues and trends and shares with supervisor, managers, and team members to facilitate root cause analysis and continuous process improvement.
Works collaboratively with other PRO departments to share feedback and ensure high functioning revenue cycle processes.
Performs any special assignments, as requested.
Qualifications Minimum Requirements:
Bachelor's degree in business or related field. Experience, in lieu of Bachelor's degree, will be considered if individual has double the required work experience.
Four years of experience in professional billing or managed care contracting/payer reimbursement.
SSM Health - System Office –
SSM Health is one of the largest Catholic health systems in the country and is dedicated to quality and compassionate care for anyone in need, regardless of ability to pay. Based in St. Louis, where its System Office is located, SSM Health operates 20 hospitals in Wisconsin, Illinois, Missouri and Oklahoma. We provide care in various settings: outpatient sites, physician offices, a pharmacy benefit company, an insurance plan, hospitals, nursing homes, home care, hospice, telehealth and a technology company.Our Mission: Through our exceptional health care services, we reveal the healing presence of God.
You’ve known us as many names throughout St. Louis, and now, we’re bringing our hospitals, doctors, home care and other services together under one name – SSM Health. With seven hospitals, 350+ physicians, more than 40 physician locations and 12,000 employees, we are part of something bigger and better. We’re connected to a wealth of resources, expertise and advance technology to help you, your fa...mily and our community live long, healthy lives.
We’ve grown and changed a lot over our 143-year history. Our name may be changing but our mission remains the same