Repricing Analyst (Revenue Cycle Specialist I)

$38,126 - $57,054/Yr

CorVel - Fort Worth, TX

Full-time - Entry Level

Remote - Fort Worth, TX

Professional, Scientific, and Technical Services

About the position

The Revenue Cycle Specialist I, also known as the Repricing Analyst, plays a crucial role in the analysis and monitoring of claims audit data across various platforms. This position is responsible for ensuring the accuracy and appropriateness of reimbursements made to healthcare providers. The specialist will engage in various follow-up activities to identify payment variances and work collaboratively with internal and external stakeholders to resolve these issues effectively. This role is designed to be performed remotely, allowing for flexibility while maintaining a focus on critical tasks. Key responsibilities include analyzing and adjusting claims to ensure reimbursement rates align with contractual agreements and payer guidelines. The specialist will establish and maintain accurate pricing structures and rules to support competitive and profitable pricing strategies across multiple claims. A significant part of the role involves identifying errors in reconciliation files across various work streams and business units, as well as performing contract and reimbursement variance analysis. The specialist will analyze claims data to detect contractual overpayments and billing errors, assisting department leadership in obtaining complex information from various financial, clinical, and operational systems. The Revenue Cycle Specialist I must stay current on billing protocols, federal and state regulations, and internal procedures that impact processing. This position requires providing subject matter expertise on billing and coding guidelines as needed. The specialist will utilize both internal and external billing protocols to repricing bills, ensuring cost savings for customers. Additionally, the role involves identifying opportunities for improvement related to policies and procedures to enhance efficiency and accuracy in bill processing. The specialist will maintain detailed knowledge and documentation of all analysis and data sources within the department, analyze all forms of Revenue Cycle transactions, and produce evaluative and statistical reports to ensure the integrity and accuracy of revenue cycle data. Confidentiality of all medical records, PHI, and PII is paramount in this role, and additional duties may be assigned as necessary.

Responsibilities

• Analyze and adjust/reprice claims to ensure accurate reimbursement rates in accordance with contractual agreements and payer guidelines.
• Establish and maintain accurate pricing structures and rules to ensure competitive and profitable pricing strategies across various claims.
• Identify errors in reconciliation files across multiple work streams and business units for multiple sites and with external partners.
• Perform contract and reimbursement variance analysis.
• Analyze claims data to identify contractual overpayments and billing errors.
• Assist department and leadership in obtaining complex information from various financial, clinical, and operational systems and data sources.
• Stay current on billing protocols and regulations, federal and state regulations, and internal procedures that affect processing.
• Provide subject matter expertise on billing and coding guidelines and regulations as required by the department.
• Utilize internal and external billing protocols and regulations for repricing bills at a cost savings to the customer.
• Identify trending opportunities related to policies and procedures to ensure efficiency and accuracy in bill processing.
• Establish and maintain detailed knowledge and documentation of all analysis/data sources within the department.
• Analyze all forms of Revenue Cycle transactions.
• Run standard Revenue Cycle and operations reports to answer questions from department/practice managers, vendors, physicians, and other Revenue Cycle stakeholders.
• Produce daily, monthly, and annual evaluative and statistical reports, analyzing drivers of variances from period to period to ensure the integrity and accuracy of revenue cycle data.
• Evaluate integrity of client data including actively participating with and supporting the Product and Account Management teams with trend analysis of payment and data variances.
• Ensure strict confidentiality of all medical records, PHI, and PII.

Requirements

• Claims repricing, pricing configuration, or provider maintenance experience required.
• 3+ years of relevant experience or equivalent combination of education and work experience.
• High School Diploma or equivalent required.
• Demonstrated knowledge of CMS guidelines and ICD-10 coding guidelines as applicable.

Nice-to-haves

• Strong understanding of claims processing, ICD-10 Coding, DRG Validation (if applicable).
• Strong understanding of healthcare revenue cycle and claims reimbursement.
• Ability to work independently and use critical thinking.
• Strong analytical and problem-solving skills.
• Strong attention to detail and ability to deliver results in a fast-paced and dynamic environment.

Benefits

• Medical (HDHP) w/Pharmacy
• Dental
• Vision
• Long Term Disability
• Health Savings Account
• Flexible Spending Account Options
• Life Insurance
• Accident Insurance
• Critical Illness Insurance
• Pre-paid Legal Insurance
• Parking and Transit FSA accounts
• 401K
• ROTH 401K
• Paid time off