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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

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