This position establishes, maintains and utilizes the Harvest Contract Management System to analyze inpatient and outpatient reimbursement, identifying all cases of inaccurate reimbursement and work with Patient Accounting to recovery any lost revenue and initiate corrective actions for future claims. Other duties include, but not limited to, the following:

• Identify all inpatient posted denials by fiscal month, reviews all accounts to identify categories and reasons, updates a YTD database, coordinates and facilitates the efforts of a Denials Team, and provide a monthly status report
• Analyze the service utilization of the capitated patient population. 
• Determine the profitability of the hospital contract and ensure that only appropriate fees and procedures are being covered in the arrangements and that these fees are revenue neutral and operational between the patient accounting department and the payer. 
• Will be identified as a hospital and corporate resource to provide information on billing and reimbursement.
• Performs analysis of Payment Variances identified using the Harvest Contract Management System.
• Performs other similar and related duties as required or directed.

Working knowledge of Harvest Contract Management System, MS Excel & MS Word required. Proficient knowledge of the SMS Financial Management System and TSI revenue modeling preferred. Detailed knowledge of regulatory requirements, particularly Medicare and Medicaid, CPT-4, HCPCS, revenue codes and ICD-9 CM. At least 3 years experience in Patient Accounts or related accounting field, Managed Care, Reimbursement or Third party Payer work. Bachelors of Art or Bachelors of Science required, Degree in Finance or Accounting preferred.

CB