Atrilogy’s direct client is seeking a Contract Definition Analyst
for an 8+ month contract
. This position is 100% Remote.
- Researching, defining, and maintaining reimbursement rules and supporting data tables for use in hospital contract management software
- Developing methods (logic) for accurately valuing inpatient & outpatient claims with a focus on Medicare valuations
- Answering valuation-related support tickets from clients
- Research and define evaluation logic primarily for Medicare hospital claims valuation, with some commercial logic on occasion as well
- Locate and research CMS hospital-reimbursement websites and occasionally commercial payer websites for adjudication rules
- Download provider manuals, reimbursement policies, and medical policies for use in hospital and applicable commercial payer valuations
- Create and maintain a schedule of download frequencies necessary for timely and accurate valuation of claims - maintain a schedule for updates
- Manipulate fee schedules for loading into the contract management software program
- Provide internal consulting for enhancement of Hospital Claims Scrubbing application
- Review client claims to verify accuracy of claims valuation
- Attend and participate in internal and client meetings as needed
- Engage in process and quality improvement activities to minimize manual efforts
DESIRED SKILLS AND QUALITIES
- Bachelor’s degree or greater in related field, or equivalent combination of education and experience
- Minimum of 3 years’ experience working in the hospital industry
- Hospital billing and/or claims management background, preferred
- In depth first-hand knowledge of Medicare adjudication methods for Inpatient and Outpatient hospital claims
- Demonstrated knowledge of coding conventions & the function of each: DRG Codes, Revenue Codes, Occurrence Codes, ICD-10, CPT and HCPCS codes
- Knowledge of the various types of health insurance payers: Medicare, Medicare Advantage Plans, Commercial Plans, Medicaid, and Medicaid Managed Care Organizations
- Broad range knowledge of different types of providers, including facility versus non-facility-based valuations
- Demonstrating overall healthcare reimbursement knowledge by obtaining satisfactory results on a Reimbursement Exam
- Engaging in deductive reasoning and critical thinking
- Exhibiting very strong attention to detail and accuracy, which is of paramount importance for role
- Demonstrating excellent skills in database platforms (Excel, Access, etc.)
- Working well in a team-oriented structure to achieve goals
- Meeting short deadlines while working independently, without supervision
- Analytical skills, Focus, Accuracy, and Timeliness are paramount qualities
For immediate consideration please submit your resume in Word format, along with daytime contact information. LOCAL CANDIDATES ONLY PLEASE
unless you are willing to relocate yourself at your own expense. Client is unable to provide H-1B Visa sponsorship at this time.
All submittals will be treated confidentially. Selected candidate may be asked to pass a comprehensive background, credit and/or drug screening. Principals only, no third parties please.
Atrilogy Solutions Group, Inc. (est. 2000), in partnership with Peak17 Consulting (est. 2008), provides organizations of all sizes with high-quality, cost effective information technology (IT) staffing services.
Atrilogy has been recognized by Inc.
magazine as one of the nation’s fastest-growing, privately held companies. Headquartered in Irvine, California, Atrilogy also has offices in Denver, Phoenix, Atlanta, and Dallas with satellite offices in Boston, Jersey City, Las Vegas, Seattle, and Delhi, India.
Clients turn to Atrilogy for expertise in:
· IT staffing and placement such as Project Managers, Agile/Scrum Masters, Business Analysts, DBAs, Software Engineers, Mobile Developers (iOS, Android), DevOps, Automation, QA, Systems & Network Engineers, Cyber Security / Information Security Specialists, ERP, CRM, Business Intelligence, Data Warehousing, Big Data and Creative (UI/UX, Web Design)
Clients tun to Peak17 for expertise in:
- Operational staffing and placement of Accounting/Finance, Human Resources, and Marketing professionals, as well as Information Technology resources.
Atrilogy Solutions Group and Peak17 Consulting are Equal Opportunity Employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, national origin, protected veteran status, or any other basis protected by applicable law, and will not be discriminated against on the basis of disability.
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.