We have an exciting opportunity to join our team as a FGP Reimbursement Analyst.
In this role, the successful candidate will be responsible for reviewing physician utilization and payment data related to managed care reimbursement. This role is responsible for creating and analyzing contract compliance reports to measure and identify revenue opportunities from commercial payers to complement the Faculty Group Practice revenue cycle operations. The incumbent will work independently with minimal supervision analyzing payer reimbursement to identify trends and payments inconsistent with contractual rates and terms. The analyst will also present and communicate their findings to Management for internal and external escalation. The candidate for this role will work collaboratively with Revenue Cycle and FGP Operations to share the findings of their analysis and contribute as needed to assist in the development of tools and educational materials for FGP front end staff. The position requires a fundamental understanding of professional billing, industry standard reimbursement methodologies as well as the ability to interpret and understand managed care contracts.
Perform audits to identify and recover underpayments caused by contract misinterpretation and invalid denials in order to maximize reimbursement, efficiently lower A/R, and expedite the revenue cycle process.
Collect and analyze data to determine denial and underpayment trends across the Faculty Group Practice for review and distribution to leadership.
Execute data mining and in-depth analysis to support managed care contracting initiatives. Maintain data integrity when manipulating data files for purposes of analysis to ensure data does not become corrupted through conscientious use of tools and a system of checks and balances. Develop a comprehensive understanding of all managed care contractual terms and reimbursement methodologies between NYU School of Medicine and external commercial payers. Evaluate and escalate eligibility, authorization, billing, and claims processing inaccuracies to the appropriate CBO and FGP Operations Management in order to implement upstream resolution and re-education. Assist with providing constructive feedback and developing training tools. Work collaboratively with a variety of departments within NYU School of Medicine and externally with commercial managed care payers. Learn appropriate new software systems to help analyze and evaluate claims data Work independently, take initiative, and think critically. Function with minimal supervision, request feedback appropriately, and initiate inquiries to gain additional understanding.
To qualify you must have a Bachelor's degree in business or healthcare administration or related field plus a minimum of two years of experience; or an equivalent combination of education or relevant work experience. High level of analytical skills and dynamic communication skills (verbal and written) are required. Microsoft Excel and Word familiarity required.
Ideal candidate will have previous experience in a healthcare finance or billing role. Skilled in data extraction, manipulation and analysis is preferred.
Qualified candidates must be able to effectively communicate with all levels of the organization.
NYU Langone Health provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.
NYU Langone Health is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision. We require applications to be completed online. If you wish to view NYU Langone Health's EEO policies, please click here. Please click here to view the Federal 'EEO is the law' poster or visit https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm for more information. To view the Pay Transparency Notice, please click here.
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Internal Number: 60239350
About NYU Langone Health
NYU Langone Health, a world-class patient-centered integrated academic medical center, is one of the nation's premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals – Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, one of only five hospitals in the nation dedicated to orthopaedics and rheumatology; and Hassenfeld Children's Hospital, a comprehensive pediatric hospital supporting a full array of children's health services across the medical center – plus the NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The medical center's tri-fold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education and research. For more information, go to www.nyulangone.org.