Senior Payor Intelligence Specialist
Company: Titus Regional Medical Center
Location: Mount Pleasant
Posted on: June 24, 2022
Job Description:
About Titus Regional Medical Center
Titus Regional Medical Center is located in Mount Pleasant, Texas.
Mount Pleasant, Texas, has a population of approximately 15,600
with major urban centers such as Dallas, Texarkana, Tyler,
Longview, and Shreveport an easy half-day drive away. This town is
where people want to live in a place where they can go to the lake
after work, where they can enjoy the simple pleasure of watching
their children play extracurriculars and even own land for farming
or ranching. Low population density, lower cost of living, and a
great location make the serenity of life in this city one of its
most outstanding features. People work hard, but they work without
the stress of living in a city where high-pressure jobs are matched
by high-pressure lifestyles. The wildlife and outdoors are all
there for those who want to venture out. We're centrally located
between several lakes, Lake Bob Sandlin State Park and Daingerfield
State Park to name a few. There are hunting, fishing, camping,
hiking, 4-wheeling, and boating activities to name a few.
More to know about Mt. Pleasant, TX:
- Local airports in Longview and Tyler with service to DFW
- Great public and private education opportunities for school-age
children
- Revitalized downtowns host boutiques, restaurants, and
events
- Secondary Education - Northeast Texas Community College
- Within 20 miles from Lake Bob Sandlin State Park and
Daingerfield State Park
- No Texas state income tax
- Dallas, TX - 2.5 hours away by car
- Texarkana, TX- 1 hour away by car
- Tyler, TX - 1.5 hours away by car
- Longview, TX - 1 hour away by car
- Shreveport, LA - 2 hours away by car
- Broken Bow, OK - 1.5 hours away by carMore to know about our
Hospital:
- Level III Trauma Center
- 1,000 births annually
- Level II NICU
- Maternal Designation
- Primary Stroke Center accredited
- Leapfrog "A" safety rating
- EMS Gold Plus AHA designation
- Accredited by The Joint Commission
- Independent health system for over 65 yearsJob: Senior Payor
Intelligence SpecialistClassification: Salaried/ExemptPosition
Summary
Reporting to the CFO, this role will be responsible for building
the payor-specific contract platform in Epic. This team member will
be responsible for the development and maintenance of a
standardized process to ensure payer contracts are accurately built
into the system, monitored for inconsistencies between contract and
payment and consistently updated with contract changes. This role
will establish relationships with government and Commercial health
plans in order to proactively capture upcoming changes to the
reimbursement policies and procedures and resolve emerging issues
affecting reimbursement. This person will collaborate with HB and
PB Revenue Cycle teams and will be responsible for managing and
resolving revenue cycle related issues with the payorsThis person
must possess strong investigative skills, intellectual curiosity
and an interest in educating and acting as a resource for Revenue
Cycle staff. This position requires the ability to understand
complex topics, particularly related to reimbursement policy
changes. Candidates must possess strong organization and
communication skills, and the ability to work as part of a team as
a subject matter expert.Essential Functions
- Build, Maintain and update payor-specific contract in Epic.
- Assist in the development of detailed strategic analysis of
hospital and professional reimbursement, including assessment of
changes to payment policies, pattern recognition across
payors/providers and ability to diagnose complex reimbursement
problems.
- Develop presentation materials to lay out the context of issues
related to the above, including relevant facts and analysis, such
that decision makers are well informed and able to make key
decisions in critical areas. Facilitate discussions of various
options including quantitative evidence and workflow
recommendations.
- Prepare monthly newsletter and ad hoc communication materials
to providers, operations personnel, revenue cycle colleagues and
others about changes to payor policies, reimbursement and contract
language.
- Lead discussions with third party payors with respect to
reimbursement issues and underpayments. Review related contract
language, payer policies and procedures, fee schedules and coding
policies in collaboration with Finance and Revenue Cycle
colleagues.
- Serve as a resource for questions from colleagues and
constituents regarding reimbursement and related issues; manage the
process for responding to ad hoc requests in a timely manner.
- Work to improve and create reports that will assist in
identifying payor-specific reimbursement issues.
- Establish constructive, professional relations with third party
payors. Schedule regular meetings and check-ins with payor
representatives to ensure a collaborative and productive
relationship.Work Experience
- Five or more years of experience in hospital and professional
claim reimbursement/analysis.
- Strong organizational skills to develop an easily searchable
and sustainable repository of detailed payor intelligence and data.
- Extensive experience with Epic required.
- Strong knowledge of both hospital and professional
reimbursement including charge capture, coding and A/R follow up.
- Creativity and deductive reasoning skills to triangulate root
causes of claim issues.
- Ability to be persuasive and use data to effectively advocate a
position with a payor to maximize payment and financial
performance.
- Outstanding documentation and communication skills to relay
detailed technical information in a succinct, actionable
manner.Education
- Bachelor's degree in a related field such as healthcare
administration or business preferred.Physical Demands and Work
EnvironmentLifting/Carrying Pushing/PullingLbs. % Time Lbs. % Time
1-10 34-66 1-10 34-6611-20 01-33 11-20 01-3321-50 01-33 21-50
01-3351-75 01-33 51-75 01-3376-100 None 76-100 NoneMovement %
TimeBend/Stoop/Twist 1-33Crouch/Squat 1-33Kneel/Crawl 1-33Reach
above Shoulder 1-33Reach below Shoulder 1-33Repetitive Arm
NoneRepetitive Hand 1-33Grasping 1-33Squeezing 1-33Climb Stairs
NoneWalking Uneven 1-33Walking Even 34-66Environment % TimeIndoors
67-100Outdoors 1-33Extreme Heat NoneDusty NoneExcessive Noise
1-33Equipment % TimeMotor Vehicles NoneFoot Pedals NoneExtreme Heat
NoneDusty NoneExcessive Noise 1-33Work near % TimeMachinery
NoneElectricity NoneSharps 0-33Chemicals 0-33Fumes 0-33Heights
NoneVisionDepth Perception RequiredColor Not RequiredPeripheral
RequiredEndurance Hours at Once Total in 12HRSit 1 3Stand 4 4.5Walk
4 4.5
Keywords: Titus Regional Medical Center, Longview , Senior Payor Intelligence Specialist, Accounting, Auditing , Mount Pleasant, Texas
Didn't find what you're looking for? Search again!
Loading more jobs...