CCS Medical

Pricing Analyst

US-FL-Clearwater
ID
2017-2036
Category
Administrative/Clerical
Position Status
Regular Full-Time
Position Schedule
Monday-Friday
Shift
8:00 - 5:00

Overview

Position Summary:

Maintain and control of all payer master file settings which insures proper claim generation in accordance with payer requirements. The success of this position is measured by denial for incorrect billing and appropriate payment on first claim submission.

Responsibilities

Essential Duties:

  • Maintains internal payer master files that are critical to proper claim generation and adjudication
  • Maintains claims adjudication system
  • Assist with updates to fee schedules for Third Party payer as needed
  • Review item file additions and changes for appropriate billing units and coding
  • Analyzes payer code changes alerting management to changes in coverage criteria that would impact CCS
  • Works with the contracting group to assess impact on the reimbursement department of new or changed third party contracts
  • Analyzes and recommends changes to reimbursement and operational processes for increased productivity
  • Develops and runs SQL and desktop applications to extract and analyze data from X12 files to support departmental needs
  • Month end analysis validating integrity of expected tables, liquidation analysis as well as other analyses as determined by Director of Contracting
  • Works as a team member with cross functional groups to promote system enhancements
  • Performs database queries
  • Maintains a high degree of confidentiality at all times due to access to sensitive information
  • Maintains regular, predictable, consistent attendance and is flexible to meet the needs of the department
  • Follows all Medicare, Medicaid, HIPAA, and Private Insurance regulations and requirements
  • Abides by all regulations, policies, procedures and standards

Performance Responsibilities:

  • Exercises appropriate cost control measures
  • Maintains positive internal and external customer service relationships
  • Maintains open lines of communication
  • Plans and organizes work effectively and ensures its completion
  • Meets all productivity requirements
  • Demonstrates team behavior and promotes a team-oriented environment
  • Actively participates in Continuous Quality Improvement
  • Represents the organization professionally at all times

Qualifications

Position Requirements & Competencies:

 

  • Associate’s Degree in Accounting, Finance or Business Management preferred and three to four years experience or a combination of education and relevant experience
  • HCPCS coding knowledge preferred
  • Demonstrated ability to read and interpret documents such as policies and procedure manuals, third party contracts, and Medicare and state Medicaid regulations
  • Ability to develop new SQL queries and update/change them when required
  • Proficient in Microsoft Office Suite. Specifically, Excel formulas, Pivot Tables, and V-lookups/Data Warehouse queries.
  • Excellent written communication skills required
  • Demonstrated ability to speak effectively before groups of customers or employees of the organization

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