Claims Analyst TC

Summary

SUMMARY:

The Claims Analyst reports to the Supervisor Claims Administration Follow-up. Under general direction and within established Brown University Health policies and procedures, performs all duties necessary to ensure all projects, ad-hoc reports and Governmental reporting requirements are processed accurately and within mandated time frames to ensure a positive reimbursement impact. Takes appropriate steps to review, identify and reduce issues resulting from project research related to Accounts Receivable follow-up activities for Brown University Health Corporate Services and its affiliates.

Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done.

The core Success Factors include:
Instill Trust and Value Differences Patient and Community Focus and Collaborate.

RESPONSIBILITIES:
Consistently applies the corporate values of respect, honesty and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly, geographically accessible and high-value services within the environment of a comprehensive integrated academic health system. Is responsible for knowing and acting in accordance with the principles of the Brown University Health Corporate Compliance Program and Code of Conduct.

Assists the Supervisors and Claim Director in compiling any necessary statistics needed for follow-up activities. Ensures timely and accurate processing of adjustments and denials from payers. Initiates action to resolve accounts. Meets with payers, Denials Management Staff and PFS staff as necessary to resolve disputes related to accounts receivable. Processes all necessary online adjustments or changes as needed, such as adding/deleting insurance information, insurance priority changes, balance transfers, demographic changes, contractual allowances, any other routine patient accounting adjustment not requiring supervisor approval.

Continually evaluates work flow and identifies opportunities to improve process for full and complete payment for all hospital services rendered to patients. Ensures accuracy, efficiency and integrity of all information systems pertaining to Government payers as well as Blue Cross and Worker's compensation. Researches payer issues resulting in payment delays, denials, underpayments and processing deficiencies and recommends changes as appropriate.

Responds to requests from various hospital personnel related to Medicare or Medicaid regulations as it applies to hospital and professional billing and reimbursement providing supporting resource information. Ensures Medicare and Medicaid 838 and 3 day overlap reports are accurately completed as required by federal regulation to ensure no interruption to Medicare and Medicaid monies paid to each affiliate. Reviews recommendations of write offs from Claims Administration Follow-Up Representatives to ensure all steps have been taken to ensure accuracy and may refer back to staff or forward on to supervisor.

Ensures all shared interdepartmental accounts receivable related files are completed accurately and referred to the appropriate department to ensure timely claims processing. Creates, generates and maintains ad hoc reports as requested by Supervisor or Director to assist in the daily operation of the department. Coordinates all assigned activities between Brown University Health and its Contracted Billing Agency for Out of State Medicaid billing and accounts receivable.

Participates in staff meetings, councils, quality improvement teams and other such meetings and committees as required. Develops and maintains working relationship with Brown University Health affiliate departments as needed to ensure fully data exchange. Responsible for completing spreadsheets needed to respond to internal and…