Reimbursement Analyst

• Analyze incoming payment information and communications from payers, physicians, and patients
• Apply contract terms, reimbursement schedules, government regulations, and internal policies
• Ensure Connecticut Children's Medical Center is paid timely and according to contracted terms
• Review payer payments and resolve hospital payment discrepancies through Epic work queues
• Review communicated payer policies
• Monitor underpaid hospital claims through full resolution
• Coordinate and lead monthly payer calls, including sharing agendas and spreadsheets
• Identify, document, trend, and quantify HB contract proration issues
• Manage HB Payer Variance work queues within EPIC
• Support billing and collection efforts related to third-party reimbursements
• Determine whether claim balances should be written off or referred to management
• Assist with ad hoc reimbursement requests using RAD reporting, contracts, and fee schedules
• Maintain confidentiality and demonstrate cultural sensitivity
• Support the organization’s mission, values, goals, and CCMC standards

• Associate degree required from an accredited college or university or equivalent experience
• Three to five years of healthcare revenue cycle or finance experience
• Knowledge of ICD-10, CPT, HCPC, and medical terminology
• Proficiency with MS Word and Excel
• Knowledge of insurance regulations and reimbursement policies
• Knowledge of EPIC HB Reimbursement Contracts
• Excellent interpersonal, communication, problem-solving, and organizational skills
• Detail oriented
• Excellent analytical skills
• Ability to analyze data, identify errors, and resolve problems in a timely manner

Demonstrates expertise in healthcare revenue cycle management, including knowledge of ICD-10, CPT, HCPC, and reimbursement policies. Proficient in analyzing payment information and resolving discrepancies while maintaining compliance with regulations and internal policies.

• Healthcare Revenue Cycle Management
• ICD-10, CPT, HCPC Knowledge
• EPIC HB Reimbursement Contracts
• Data Analysis and Problem Resolution
• MS Word and Excel Proficiency

• Healthcare Revenue Cycle Management
• ICD-10 Knowledge
• CPT Knowledge
• HCPC Knowledge
• EPIC HB Reimbursement Contracts
• Data Analysis
• Reimbursement Policies
• Payment Discrepancy Resolution
• Contract Terms Application
• Ad Hoc Reimbursement Requests

• Interpersonal Skills
• Communication Skills
• Problem-Solving Skills
• Organizational Skills
• Detail Oriented

• Healthcare
• Payer Policies
• Third-Party Reimbursements
• Confidentiality
• Cultural Sensitivity

• EPIC
• MS Word
• MS Excel
• RAD Reporting