Managed Care Revenue Optimization Analyst - FT

Memorial Healthcare System - Hollywood, FL

Full-time - Mid Level

Hollywood, FL

Hospitals

About the position

The Managed Care Revenue Optimization Analyst plays a crucial role in reviewing and analyzing denials and short payments from insurance plans. The position focuses on determining the best resolution strategies to obtain payments in accordance with payor contracts and applicable laws. This role requires effective communication and critical thinking skills to interact with clinical teams and report payment trends, ensuring compliance with managed care policies.

Responsibilities

• Review and analyze denials and short payments from insurance plans.
• Interact with the Department Clinical Team to obtain necessary clinical facts.
• Identify and report payment and denial trends for assigned payors.
• Meet and maintain production and quality standards defined by department policies.
• Evaluate authorization, coding, billing, and correspondence to identify issues.
• Compile detailed written appeal documents outlining positions for payment.
• Track outcomes of payment requests to ensure timely follow-up actions.
• Reconcile and update business systems and reports with findings.
• Create and maintain spreadsheets of open accounts.
• Work directly with plan contacts to exchange data and identify root causes.

Requirements

• High School Diploma or Equivalent required.
• Two years of experience in a hospital/physician business office, managed care collections, or claims environment required.
• Intermediate knowledge of Microsoft Word and Excel.
• Detailed knowledge of government and managed care insurance terminology and reimbursement methodologies.
• Knowledge of federal and state regulations related to payment for medical services.
• Ability to formulate and write formal business communications.