Duties of this position include but are not limited to: In this absence of the Assistant Director, the Underpayment Specialist can address internal and external inquires related to third party payor reimbursement. Assist the Assistant Director, as needed in the review and approval of certain single case agreements (e.g., agreements that reimburse ECUP at no less than 90% of billed charge and will provide ECUP with reimbursement within 30 days from the date of service). Acts as a primary liaison between the Managed Care Department and our AR team to address findings related to claims research conducted in Experian. Monitor overall third-party payor payment performance. Responsible for resolving Third Party Payor underpayments identified via the Experian Contract Application. Submit, track, and follow-up on underpayment reports to ensure that additional reimbursement is secured. Uses Experian's Contract Analysis tool to identify and report the positive or negative financial impact of contracting with third party payors. Communicates specialized knowledge of reimbursement methodologies used by commercial and governmental payors in the contract analysis process. Designs and using analytical tools, drawing statistically sound conclusions and presents results to management. Analyzes incoming payment information and other communications (from payer, physician, and patient) along with applicable contract terms, reimbursement schedules, government regulations and internal policies. The intent is to support provider contract negotiations, assess the impact of potential alternative reimbursement models, provide management with the ability to assess the impact of policy changes, and government mandates that impact reimbursement, Monitor third party payor contract performance. Develop and monitor reports that identify underpayment trends, under-allowed charges, additional revenue secured from addressing underpayments, etc. Attend and participate in contract implementation meetings. Develop and maintain a relationship with ECUPs Experian contact and external colleagues that use Experian to help ECUP maximize system functionality. Submit support tickets to Experian to address any system issues that cause of claims to not value correctly. Submit support tickets to Experian to add contracts to the system. Respond to requests for allowables from internal customers. Assists the Credentialing Officer and the Provider Relations Coordinate with special projects linked to the credentialing process. Such activities are approved in advance by the Assistant Director (e.g., populating LME/MCO provider applications) Monitor and address negative trends related to the Credentialing Denial WQ: 192391 Special Projects as assigned by the Assistant Director.
CLINICALSUPPORTPOSITION – NOTSUBJECT TO STATEHUMANRESOURCESACT.
The ECU Brody School of Medicine is affiliated with Vidant Medical Center. Vidant Medical Center is the flagship hospital for Vidant Health and serves as the teaching hospital for the Brody School of Medicine at East Carolina University.
Special Instructions To Application:
Please ensure your full range of knowledge, skills, abilities, experience and education are listed on your application. Do not write ‘see resume’ on your application when completing the job duties section.
If you answer the questions at the end of the application, please ensure your application reflects the knowledge, skills, abilities and experiences to support your answers (see job duties section of previous employment).
Failure to answer the questions at the end of the application will not preclude your application from being considered but may result in your application not receiving full consideration of your knowledge, skills, and abilities.
Applicants must be currently authorized to work in the United States on a full time basis.
Bachelor’s degree and one year of experience related to the area of assignment; or equivalent combination of training and experience. All degrees must be received from appropriately accredited institutions.
Full time or Part time: Full Time
Position Location (city): Greenville
Position Number: 951111
Organizational Unit Overview:
Clinical Finance and Business Support Services/Group Practice Administration is responsible for the clinical and administrative oversight of the group practice for ECU Physicians. The practice is comprised of approximately 360 faculty physicians, 52 contracted providers and employs a diverse clinical support staff of more than 1,200 individuals, of which approximately 350 employees are working within revenue cycle operations The practice provide approximately 550,000 outpatient, 155,000 emergency room and 126,000 inpatient services annually to nearly 160,000 patients. Clinical Finance and Business Support Services reports to the ECU Physicians (ECUP) Executive Director and ECUP Chief Financial Officer to support key fiscal and operational components of the clinical practice and revenue cycle operations. These include direct management responsibility for staffing and operations in the centralized functions of the Central Billing Office (CBO) and oversight for decentralized activities. Centralized functions include: Payor Contracting and Evaluation, Regulatory Compliance and Credentialing; Computer System and Procedure Training; Insurance and Patient Billing, Follow-up and Collections; Cash Management of Professional Fee Revenue; Business Intelligence Services such a Reporting and Analytics; Coordinated Patient Access Support; and Contact Center Decentralized functions include: Registration, Referral Management, Pre-Service Financial Preparation; Service Identification and Reconciliation; Coding and Charge Entry; and Project Management and Process Improvement.
To be a national model for student success, public service and regional transformation, East Carolina University uses innovative learning strategies and delivery methods to maximize access; prepares students with the knowledge, skills and values to succeed in a global, multicultural society; develops tomorrow's leaders to serve and inspire positive change; discovers new knowledge and innovations to support a thriving future for eastern North Carolina and beyond; transforms health care, promotes wellness, and reduces health disparities; and improves qualify of life through cultural enrichment, academics, the arts, and athletics. We accomplish our mission through education, research, creative activities, and service while being good stewards of the resources entrusted to us. East Carolina University delivers on the promise of opportunity. We open doors. We improve lives. We transform the present, and we discover the future. In these ways and more, we serve our community, our state, our nation and our world as together we reach toward our greatest potential. Tomorrow starts here.