Senior Revenue Cycle Reimbursement Analyst

Position Summary:

The Senior Revenue Cycle Reimbursement Analyst for Patient Financial Services will be responsible for maintaining and auditing expected reimbursement calculations within the Patient Accounting systems. Additionally, this position will work closely with the Hospital Joint Operating Committees to identify trends in payment errors and payment policies. The candidate’s background requires an in depth knowledge of both governmental and commercial reimbursement schemes as well to the ability to perform complex reporting and analysis relating to payment variances from contract terms.

Job Responsibilities:

• Analyzes and audits claims, payments and remittance data to identify non-compliance with negotiated contract terms.
• Updates and maintains contracting terms including coding and system setup in Patient Accounting Contract Management tools.
• Assists in the preparation of Joint Operating Committee spreadsheets and develop regular reporting on recovery activities for the Hospital.
• Serves as a liaison with managed care representatives to facilitate the explanation or resolution of questionable claim adjudications based on plan EOBs or other documentation.
• Maintains knowledge of Medicare, Medicaid and Commercial reimbursement. Stays abreast of group payer contracts, payer policies, payer plans, and member benefits.
• Keeps apprised of Medicare & Medicaid updates impacting hospital reimbursement (e.g. regulations, reimbursement factors, fee schedules, etc.).
• Monitors and tracks ongoing payer performance through the development of Payer Scorecards and key performance indicators (KPI) in comparison to industry benchmarks.
• Assists in providing training to PFS staff on contract interpretation including processes and procedures to maximize reimbursement.
• Develops and maintains proficiency with complex queries and reporting.
• Performs special projects and duties as needed or assigned.

Required Qualifications:

• Bachelor’s degree and 3 years' revenue cycle, medical billing or follow-up experience.
• In lieu of degree, a minimum of 7 years' healthcare revenue cycle experience.
• Detailed knowledge of Medicare, Medicaid and Commercial reimbursement methodologies.
• Proficiency in MS Office Suite including: Excel, Word, Access, Visio, PowerPoint.
• Knowledge and proficiency of SQL or Database reporting queries.Knowledge of Contract Management systems.
• Knowledge of Contract Management Systems.
• Knowledge of CPT, HCPCs and ICD-10 coding principles.
• Demonstrated ability to manage a process and timelines.
• Demonstrated analytical skills – ability to break down problems and processes.
• Excellent written and verbal communication skills.

Preferred Qualifications:

• Master’s degree in Accounting/Finance, Health Information Management, Health Administration, Computer Science or related field.
• Medical Coding Certification through the American Academy of Professional Coders (AAPC) and/or the American Health Information Management Association (AHIMA).
• Experience reporting from healthcare decision support, patient accounting, contract management and/or claims scrubber systems.

Special Notes: Resume/CV should be included with the online application.

In accordance with federal and state regulations that all hospitals and nursing homes require personnel to be vaccinated against COVID-19, candidates who are not already fully vaccinated must obtain the first dose of a COVID-19 vaccine within three (3) calendar days of acceptance of a conditional job offer and must obtain any subsequent doses in accordance with that particular vaccine manufacturer’s protocol. Candidates who are partially vaccinated, but not yet fully vaccinated, must complete their vaccination series within three (3) calendar days of a job offer or in accordance with that particular vaccine manufacturer’s protocol, whichever comes later.

The state regulation also includes those who may be affiliated with or interact with employees of a hospital or nursing home. The regulations allow for limited exemptions with reasonable accommodations, consistent with applicable law.

Posting Overview: This position will remain posted until filled or for a maximum of 90 days. An initial review of all applicants will occur two weeks from the posting date. Candidates are advised on the application that for full consideration, applications must be received before the initial review date (which is within two weeks of the posting date).

If within the initial review no candidate was selected to fill the position posted, additional applications will be considered for the posted position; however, the posting will close once a finalist is identified, and at minimal, two weeks after the initial posting date. Please note, that if no candidate were identified and hired within 90 days from initial posting, the posting would close for review, and possibly reposted at a later date.

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• Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
• All Hospital positions maybe subject to changes in pass days and shifts as necessary.
• This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
• This function/position maybe designated as “essential.” This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.

Prior to start date, the selected candidate must meet the following requirements:

• Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services*
• Complete electronic reference check with a minimum of three (3) professional references.
• Successfully complete a 4 panel drug screen*
• Meet Regulatory Requirements for pre employment screenings.
• Provide a copy of any required New York State license(s)/certificate(s).

Failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.

• The hiring department will be responsible for any fee incurred for examination.

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Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.

If you need a disability-related accommodation, please call the University Office of Equity and Access at (631)632-6280.

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