Contract Reimbursement Specialist - PFS Revenue Integrity - Sharp Corporate - Day Shift - Full Time

Hours:

Shift Start Time:
Variable
Shift End Time:
Variable

AWS Hours Requirement:
8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:
As Needed

On-Call Required:
No

Hourly Pay Range (Minimum - Midpoint - Maximum):
$41.440 - $53.470 - $65.490

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do
Accountable for the accuracy of accounts receivable balances for both government and non-government payors. Acts as primary contact between PFS and Contracting Department with ultimate goal of resolving AR inventory thought clear identification and articulation of payor issues.

Required Qualifications

• Bachelor's Degree
• 5 Years experience with managed care contract negotiation and/or interpretation.
• 3 Years experience with patient accounts receivable systems (system actions, data extraction and report writing).

Preferred Qualifications

• Master's Degree
• Experience with patient financial accounts receivable.

Essential Functions

• Data reporting
  Facilitating QC Audit process, including management of workload and data extraction for audits.
  Creating department reports to show quality scores, Flame Reports, and identification of error trends.
• Department competency
  Researching and interpreting legal language for application to contract reimbursement and billing and educates staff as necessary.
  Responsible for knowledge of every payor's dispute resolution process and ensuring adherence with guidelines.
• Financial analysis and reporting
  Accurately and in a legally defendable accounts receivable format for submission to payors grouped by no pay and underpay reasons (includes government payors).
  Participates in payor meetings to clearly articulate status of accounts receivable inventory.
  By drafting, developing templates and/or approving contract appeal documents, payment demand notices, payor and CEO requests for Meet and Confer.
  Developing tools to facilitate net revenue recovery and develops reports, as necessary.
  Regularly analyzes accounts receivable data for trending purposes. From analysis, develops action plan to resolve open inventory effectively and efficiently.
• System integration
  Acting as primary contact between PFS and Contracting Department.
  Reviewing and providing input during contract negotiations based upon knowledge of industry, as well as staff and system capabilities.
  Delivering in-service to PFS staff for newly negotiated contracts for better understanding of new provisions and rate methodologies. Involves contracting department, as necessary, to settle payor disputes.

Knowledge, Skills, and Abilities

• Demonstrated expertise in Microsoft Office applications (Word, Excel, Outlook and Project).
• Aptitude for learning additional software applications such as MS Access.
• Must possess strong analytical and mathematical skills to resolve accounts receivable inventory.
• Strong communication and excellent interpersonal skills.
• Team player.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class