Reimbursement Analyst; FGP

NYU Langone Health is a fully integrated health system that consistently achieves the best patient outcomes through a rigorous focus on quality that has resulted in some of the lowest mortality rates in the nation. Vizient Inc. has ranked NYU Langone the No. 1 comprehensive academic medical center in the country for three years in a row, and U.S. News & World Report recently placed nine of its clinical specialties among the top five in the nation.

NYU Langone offers a comprehensive range of medical services with one high standard of care across 6 inpatient locations, its Perlmutter Cancer Center, and over 320 outpatient locations in the New York area and Florida. With $14.2 billion in revenue this year, the system also includes two tuition-free medical schools, in Manhattan and on Long Island, and a vast research enterprise with over $1 billion in active awards from the National Institutes of Health.

For more information, go to NYU Langone Health, and interact with us on Linked In, Glassdoor, Indeed, Facebook, X, You Tube and Instagram.

We have an exciting opportunity to join our team as a Reimbursement Analyst. In this role, the successful candidate will be responsible for reviewing physician utilization and payment data related to managed care reimbursement. This role is responsible for creating and analyzing contract compliance reports to measure and identify revenue opportunities from commercial payers to complement the Faculty Group Practice revenue cycle operations.

The incumbent will work independently with minimal supervision analyzing payer reimbursement to identify trends and payments inconsistent with contractual rates and terms. The analyst will also present and communicate their findings to Management for internal and external escalation. The candidate for this role will work collaboratively with Revenue Cycle and FGP Operations to share the findings of their analysis and contribute as needed to assist in the development of tools and educational materials for FGP front end staff.

The position requires a fundamental understanding of professional billing, industry standard reimbursement methodologies as well as the ability to interpret and understand managed care contracts.

• Evaluate and
  ** escalate
  * * eligibility, authorization, billing, and claims processing inaccuracies to the appropriate CBO and FGP Operations Management in order to implement upstream resolution and re-education.
• Function with minimal supervision, request feedback appropriately, and initiate inquiries to gain additional understanding.
• Perform audits to identify and recover underpayments caused by contract misinterpretation and invalid denials in order to maximize reimbursement, efficiently lower A/R, and expedite the revenue cycle process.
• Collect and analyze data to determine denial and underpayment trends across the Faculty Group Practice for review and distribution to leadership.
• Execute data mining and in-depth analysis to support managed care contracting initiatives.
• Assist with providing constructive feedback and developing training tools.
• Work collaboratively with a variety of departments within NYU School of Medicine and externally with commercial managed care payers.
• Learn appropriate new software systems to help analyze and evaluate claims data.
• Work independently, take initiative, and think critically.
• Maintain data integrity when manipulating data files for purposes of analysis to ensure data does not become corrupted through conscientious use of tools and a system of checks and balances.
• Develop a comprehensive understanding of all managed care contractual terms and reimbursement methodologies between NYU School of Medicine and external commercial payers.