Job Description

Job Description

Job Description

Responsibilities

Artificial Intelligence; Advanced Technology; The very best in patient care. With decades of expertise, RadNet is Leading Radiology Forward . With dynamic cross-training and advancement opportunities in a team-focused environment, the core of RadNet’s success is its people with the commitment to a better healthcare experience. When you join RadNet as Contract Compliance Revenue Analyst , you will be joining a dedicated team of professionals who deliver quality, value, and access in the 21st century and align all stakeholders- patients, providers, payors, and regulators achieve the best clinical outcomes.

JOB SUMMARY

This position will be responsible for analyzing and coordinating results from the Revenue Assurance Module (“RAM”) within the National Payor Database (“NPD”). The RAM is primarily driven by the weekly EOB variance reporting process to ensure the accuracy of allowed amounts (for procedures performed) from payors with whom RadNet has a contractual relationship. This position will also interface with Reimbursement Operations (“RO”), RO Systems Support, Credentialing, Marketing and Communications and Payor Relations personnel to ensure that variances are fully researched and that proper follow-up is performed to maximize the Company’s revenue.

You will:

• Duties of this position involve weekly receipt of the RAM Variance Reports for each RadNet practice from the Payor Contract Coordinator position (within Payor Relations) and performing an analysis (via Excel sort, filtration and pivot tables) of the data in order to isolate those variances in need of further research. This analysis will result in carve-out and archiving of zero and de minimis variances as well as variances stemming from CBP/MSP (Contiguous Body Part/Multiple Surgical Procedure) reductions, modifier reductions, and payor denials.
• Performs the necessary research on variances which remain after the weekly carve-out process to identify accounts with potential financial recovery of variances. This research will involve extensive use of our billing systems, the NPD and other data sources to determine the viability of revenue recovery.
• For accounts with potential revenue recovery, notify the appropriate RO liaison as well as our contracting department who will be responsible for the appellate process of these charges and provide the liaison with information needed to accomplish the re-bill or appeal.
• Maintains open dialogue with RO personnel and contracting within each practice regarding status of open appeals.

If You Are:

• Associates or Bachelors degree preferred.
• At least four (4) years of experience in a health care/third-party reimbursement administrative environment. Specific certifications and/or designations within the health care field (administrative vs. clinical) functions are strongly desired and may be considered in lieu of the work experience requirement
• Proficiency with Microsoft Office applications, with strong Excel data analysis skills. Must pass intermediate level Excel test with a 80% or higher.
• Knowledge and understanding of payors, contracting, insurance types/classes, CPT codes and fee schedule structure and various health care regulations.
• Understands the proprietary nature of fee schedules and associated contracts and will not release any of this proprietary information without prior written consent.
• Understanding of revenue cycle process flow.
• Strong written, verbal and interpersonal communication skills.

Ideal Candidate will possess:

• Communicates, cooperates, and consistently functions professionally and harmoniously with all levels of supervision, co-workers, patients, visitors, and vendors.
• Demonstrates initiative, personal awareness, professionalism and integrity, and exercises confidentiality in all areas of performance.
• Follows all local, state and federal laws concerning employment to include but not limited to: I-9, Harassment, EEOC, Civil rights and ADA.
• Follows OSHA regulations, RadNet and site protocols, policies and procedures.
• Follows HIPAA, compliance, privacy, safety and confidentiality standards at all times.

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