SUMMARY:

The Reimbursement Analyst I is responsible for the appropriate management of assigned accounts.  Responsibilities include calling insurance companies to resolve authorization and claim denials, writing appeals and letters to insurance companies to resolve denials, and following up on appeals to the point of exhaustion or payment.

 ESSENTIAL DUTIES AND RESPONSIBILITIES 

*This is not an inclusive list.  Other duties may be assigned

• Resolve, call and/or appeal a defined number of accounts per day as instructed by management.
• Draft appeals and letters to insurance companies.
• Make proper notations in Quantum on all accounts.
• Understand and utilize payer contracts and provider manuals when disputing denials.
• Use proper approved note structure when notating all accounts.
• Follow up on all appeals, claims, letters or other documentation within 20 days or less of the submission.
• Follow up on all payments at the time an overturn letter is received.
• Demonstrate an understanding of office workflow by completing the Medtrak tab, Denials tab, Verification tab, and Notes tab correctly.
• Ensure that assigned accounts are appealed timely through the use of Quantum Appeals worklist.
• Maintain worklist through daily audits and the open task report.  
• Ensure that all assigned cases have a follow up and that there are no duplicate follow ups.
• Address all follow ups promptly. o Alerts must be addressed within a day of receipt. o Initial call requests must be addressed within two days from the receipt of the follow up. o Follow ups should never be more than 14 days old.
• Hand any RUSH cases directly to the responsible party for review. o A RUSH is any appeal or submission that is due within two weeks from the date the due date was verified.
• Maintain one follow up in each assigned account and refrain from unnecessary duplicate follow ups on worklist.
• Indicate the referred amount of all first level administrative appeals filed through the daily worklist.
• Obtain prior approval from a Lead Reimbursement Analyst, Supervisor, or management for all modifications to a UB-04; including, but not limited to, additions, changes or removals to/from the original claim provided by the facility.
• Follow all HIPAA guidelines

 COMPETENCIES:  To perform the job successfully, an individual should demonstrate the following competencies: 

• ANALYTICAL - Synthesizes complex or diverse information; Collects and researches data. 
• PROBLEM SOLVING - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully.
• INTERPERSONAL SKILLS - Focuses on solving conflict, not blaming; Maintains confidentiality. 
• ORAL COMMUNICATION - Listens and gets clarification; Responds well to questions. 
• WRITTEN COMMUNICATION - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Able to read and interpret written information. 
• TEAMWORK - Balances team and individual responsibilities; Contributes to building a positive team spirit. 
• PROFESSIONALISM - Accepts responsibility for own actions; Follows through on commitments. 
• QUALITY - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality. 
• ATTENDANCE/PUNCTUALITY - Is consistently at work and on time. 
• DEPENDABILITY - Follows instructions, responds to management direction; Commits to long hours of work when requested by management to reach goals. 
• INITIATIVE - Takes independent actions; Asks for and offers help when needed.

QUALIFICATIONS 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed 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. 

 EDUCATION AND/OR EXPERIENCE 

Bachelor's degree from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience. 

LANGUAGE SKILLS 

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports and business correspondence. Ability to effectively present information and respond to questions from managers, clients, customers, and the general public. 

MATHEMATICAL SKILLS 

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. 

 REASONING ABILITY 

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. 

COMPUTER SKILLS 

To perform this job successfully, an individual should have knowledge of internet software; spreadsheet software and word processing software. 

PHYSICAL DEMANDS 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit for extended periods of time; use hands to touch, handle or feel; and reach with hands and arms. 

WORK ENVIRONMENT 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Required Skills Required Experience

• Minimum of a Masters degree in a health related field. PA, NP, MD, PhD, PsyD, EdD, DSW preferred.
• License in respective healthcare field. Certified Brain Injury Specialist (CBIS) certification preferred.
• Must have experience in the care of patients with TBI – in-patient, out-patient, or rehabilitation settings.
• Knowledge of theoretical frameworks related to leadership, healthcare management and administration required.
• Must have managerial experience and outstanding skills to track, monitor, and quality control programs at different sites and supervise personnel.
• Experience and familiarity with military health care system, military command structure, rules and regulations and its unique culture preferred.
• Must be able to adhere to legal, professional, and ethical codes with respect to confidentiality and privacy
• Must be a US Citizen
• Must be able to travel to various network sites and meeting venues

DLH CORPORATION IS AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, PREGNANCY, SEXUAL ORIENTATION, GENDER IDENTITY, NATIONAL ORIGIN, AGE, PROTECTED VETERAN STATUS, OR DISABILITY STATUS.