Description

Summary

The Payer Contract & Reimbursement Specialist supports operational decision-making through communication with Tulane University Medical Group (TUMG) leadership, maintains payor relationships, and contributes to revenue optimization strategies. This person is responsible for monitoring contractual allowances, analyzing and pursuing appeal opportunities with payors and networks and reporting appeals performance. The Specialist serves as the liaison with payors and vendors to ensure timely and accurate uploads and data integrity, helping to support timely and accurate reimbursement from payors. This role will support both recurring and ad hoc payor reimbursement analysis and assist in implementing optimization strategies.

Required Knowledge, Skills, and Abilities

• Clear and professional communication with team members, providers, payers, and other stakeholders.
• Energetic and motivated as a self-starter and the ability to work independently to help identify trends that impact billing.

• Understanding of managed care, government contracts, and reimbursement processes.

• Strong data analysis skills with the ability to compile and interpret complex data sets related to contract compliance and payment trends.

• Extensive knowledge of medical coding systems (ICD, CPT, HCPCS, etc.) and payor fee schedules.

• Ability to maintain confidentiality in all work performed.

• Excellent organizational and time management skills; ability to effectively manage multiple tasks simultaneously and meet established deadlines.

• Excellent skills using MS Word, Excel and PowerPoint

Required Education and/or Experience

• High School Diploma or general educational development (GED) equivalent with three (5) years relevant experience in revenue cycle, medical coding or payor relations.

Preferred Qualifications

• Bachelor's Degree with two (2) years' experience in revenue cycle, medical coding, or payor relations.
• Experience with government and commercial payor contracting.
• Experience with hospital or clinical charge description master (CDM) and payor fee schedules; knowledge of global fees, professional fees, and technical fees; experience in medical billing, or coding practices and procedures.

• Demonstrated proficiency in the utilization of Data Visualization tools such as Power BI.