Payment Review Analyst

Prime Healthcare • Lewiston, ME

22h

About The Position

Overview Central Maine Healthcare is an integrated healthcare delivery system serving 400,000 people living in central, western and Midcoastal Maine. CMH's hospital facilities include Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital. CMH also supports Central Maine Medical Group, a primary and specialty care practice organization. Other system services include the Central Maine Heart and Vascular Institute, a regional trauma program, LifeFlight of Maine's southern Maine base, the Central Maine Comprehensive Cancer Center and other high-quality clinical services. Responsibilities Under the supervision of the PFS Director, the Payment Review Specialist position is responsible for accurate and timely payment analysis of managed care contracts to determine that appropriate reimbursement is received. Utilizing many complex and varying regulations, guidelines and systems, analyzes payments received from insurance companies to assure maximum and correct reimbursement receivables. Proactively works with payers and in-house resources to identify and resolve issues that hinder optimal and correct account payment. Utilizes and applies the appropriate regulations in order to assure compliance in payment practices.

Requirements

• Minimum three years hospital billing and collection experience
• Medical and Insurance terminology essential
• Knowledge of CPT, ICD-9, HCPCS coding structures

Responsibilities

• responsible for accurate and timely payment analysis of managed care contracts to determine that appropriate reimbursement is received
• analyzes payments received from insurance companies to assure maximum and correct reimbursement receivables
• works with payers and in-house resources to identify and resolve issues that hinder optimal and correct account payment
• applies the appropriate regulations in order to assure compliance in payment practices

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed