At Boston Children's Hospital, success is measured in patients treated, parents comforted and teams taught. It's in discoveries made, processes perfected, and technology advanced through major medical breakthroughs and small acts of kindness. And in colleagues who have your back and patients who have your heart. As a teaching hospital of Harvard Medical School, our reach is global and our impact is profound. Join our acclaimed Physician's Organization and discover how your talents can change lives. Yours included.
This Case Mix/Reimbursement Analyst I will be responsible for:
Gathering data to perform detailed analyses of Commercial, Managed MCD/MCO and National plans contract analyses.
Preforming payor detail account transaction activity, reviewing insurance payment accuracy, inappropriate payors deviations, interpreting trends and making recommendations for corrective action.
Conducting data analysis to identify trends both related to systematic configuration and payor issues to improve department operations.
Creating reports within EPIC and Contract Manager, summarizing data and its findings in an effective manner.
Communicating reports to key department stakeholders and leverage the reports' insights to drive Reimbursement improvement projects.
Working towards improving and identifying build or system configuration rules that impact the proper value of underpaid claims or reimbursement.
Working with improvement project team to understand and assist with tracking of key initiatives, metrics, and project assignments.
Responsible for completing projects in a timely manner.
Staying current with changes in reimbursement and payor policies and uses this knowledge to develop or modify/update underpayment system.
Collaborating with PO leadership to improve payor performance, resolve reimbursement trends, and stay abreast of future policy/payor challenges/changes. Building strong relationships with payors.
Collaborating with management to complete projects in a timely manner.
To qualify you must have:
The knowledge of theories, principles, and concepts typically acquired through completion of a Bachelor's degree in Accounting or a closely related field and two (2) plus years of related experience.
The analytical skills to collect information from diverse sources, apply professional principles in performing various analyses, and summarize the information and data in order to solve problems or design relatively complex systems and programs that cross department/divisional lines.
Excellent communication skills in order to effectively deal with conflicting views or issues and mediate fair solutions or well-developed writing skills.
Demonstrated professional integrity.
The ability to identify problems and issues of varying complexities and to find effective solutions with few guidelines.
Attention to detail, good organizational skills, ability to meet priorities within set timeframes, and ability to work as part of a team.
The ability to apply critical and strategic thinking.
Boston Children's Hospital offers competitive compensation and unmatched benefits, including an affordable health, vision and dental insurance, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition Reimbursement, and discounted rates on T-passes (50% off). Discover your best.
Boston Children's Hospital is an Equal Opportunity / Affirmative Action Employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.
Internal Number: 2905789
About Boston Children's Hospital
Boston Children's Hospital is a 395-bed comprehensive center for pediatric health care. As one of the largest pediatric medical centers in the United States, Children's offers a complete range of health care services for children from birth through 21 years of age.