Payor Reimbursement Analyst


The Payor Reimbursement Analyst will support the financial sustainability of the organization through timely , accurate and thorough research of reimbursement issues related to Medicaid and Commercial payors. Responsible to track, trend and reconcile data and report to the Revenue Cycle. Develop and maintain collaborative relationships with payors, Access, Clinics, Managed Care, Business Operations, Leadership and Legal departments.

Roles Responsibility
Provide timely, comprehensive and accurate review of authorizations/denials, Provide clear direction to others to resolve authorization/denial issues, Provide timely appeals based on standardized criteria, Monitor payor response to appeals, Track, trend and analyze all authorization issues and denials by payor, Report data on a weekly, monthly, quarterly or yearly basis, Communicate and collaborate with internal and external partners to optimize reimbursement, Develop cogent, comprehensive appeals utilizing standardized criteria or evidence, Contribute to the education of CRM, Medical, and other hospital staff about authorization and denials, Partner in the mission and upholds the core principles of the organization, Anticipate and respond to customer needs, Demonstrate collaborative and respectful behavior, Contribute to a positive work environment, Use resources efficiently
Desired Qualification
Bachelor of Science in Nursing, Master of Science in Nursing
Full Time
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