Revenue Recovery and Contract Analyst

Austin Regional Clinic - Austin, TX

Full-time - Entry Level

Austin, TX

Ambulatory Health Care Services

About the position

The Austin Regional Clinic is seeking a dedicated individual to join our team as a Contract Manager. This role is pivotal in the review, coordination, and appeal of denied and underpaid claims. The successful candidate will be responsible for preparing appeals, discussing denials with payer representatives, and monitoring the outcomes of follow-up activities. All duties must be carried out while respecting patient confidentiality and promoting the mission and philosophy of the organization. As a Contract Manager, you will complete financial impact analyses of contract negotiations, including modeling contract proposals and reporting on their impact. You will interpret managed care contract terms, validate understanding, and ensure that all contracts in the system are current and calculating correctly. Evaluating underpayments and overpayments for possible overturn opportunities will be a key responsibility, as well as generating and submitting appeals and tracking their progress. In addition, you will communicate payer contracting and fee schedule issues impacting claims to management, prepare monthly reports, and serve as the point of contact for fee schedule inquiries. You will also work closely with Revenue Integrity leadership to understand contract specifics and provide data to support negotiations with payers. This position requires a proactive approach to identifying and escalating consistent issues and trends with payers to support leadership in resolving these issues effectively. The role also involves utilizing Epic for claims follow-up, managing accounts assigned to work queues, maintaining correspondence levels, and processing claims in Epic Account Maintenance. You will be expected to provide call-center backup to Customer Service and Registration teams, verify insurance eligibility, and assist coworkers as necessary. The ideal candidate will have a strong background in billing, claim denial management, and registration modules, with a focus on managed care contracts and payer payment methodologies.

Responsibilities

• Complete financial impact analysis of contract negotiations, including modeling of contract proposals and reporting of contract proposal impact.
• Interpret managed care contract terms and validate understanding, modeling relevant parameters into contract model applications.
• Evaluate underpayments and overpayments for possible overturn opportunities and identify contract update needs.
• Generate and submit individual or mass appeals, creating appeal letters and working with payer representatives.
• Track appeals and recoveries, performing regular follow-up on outstanding appeals.
• Report possible contract and payer discrepancies and recommend contract record updates as necessary.
• Communicate payer contracting/fee schedule issues impacting claims to management and prepare monthly reports.
• Identify and escalate consistent issues and trends with payers to support leadership in resolving issues.
• Serve as point of contact for fee schedule allowed amount inquiries.
• Submit support requests regarding contract record or claim valuation inquiries.
• Work closely with Revenue Integrity leadership to understand contract specifics and provide data to support negotiations.

Requirements

• High school diploma or equivalent.
• At least 5 years of experience working with Epic billing, claim denial management, and registration modules, or with managed care contracts.
• At least 2 years of experience working with accounts receivables, effectively pursuing payments from carriers and customers.
• Excellent customer service skills.
• Knowledge of and/or experience with billing and collecting from Medicare, Medicaid, and Commercial Insurance.
• Basic knowledge of insurance contracts and fee schedules.
• Knowledge of and/or experience with procedural and diagnostic coding.
• Strong skills with Microsoft Excel and computer data processing systems.
• Excellent verbal and written communication skills.
• Strong analytical and problem-solving skills.

Nice-to-haves

• Experience working with CMS/ARC billing & collections functions.

Benefits

• Medical
• Dental
• Vision
• Flexible Spending Accounts
• PTO
• 401(k)
• EAP
• Life Insurance
• Long Term Disability
• Tuition Reimbursement
• Child Care Assistance
• Health & Fitness
• Sick Child Care Assistance
• Development opportunities.