Operations Analyst

Job Summary

Researches, identifies, and rectifies any circumstances affecting delayed submission of insurance accounts or payment of accounts.

Responsibilities

• Provides feedback / education to staff to prevent reoccurrence of insurance account issues.
• Ability to analyze trends and determine root cause of billing problems.
• Maintains knowledge of all Federal and state billing regulations and guidelines.
• Prepares and reviews reports/ documents with appropriate staff as required.
• Identifies opportunities for improvement within MMS CBO/Practice work flow processes.
• Demonstrates ability to identify issues outside work flow process and escalates them when necessary.
• Identifies and monitors incorrect reimbursement and coding issues.
• Identifies and applies appropriate adjustments per contracts or state requirements.
• Follows-up on all previously sent reconsiderations for proper payment.
• Communicates with payors regarding issues and resolutions.
• Performs other duties as assigned

Knowledge, Skills & Abilities

Patient Group Knowledge (Only applies to positions with direct patient contact)The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department's identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients.Competency StatementMust demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist.Common Duties and Responsibilities(Essential duties common to all positions)1. Maintain and document all applicable required education.2. Demonstrate positive customer service and co-worker relations.3. Comply with the company's attendance policy.4. Participate in the continuous, quality improvement activities of the department and institution.5. Perform work in a cost effective manner.6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations.7. Perform work in alignment with the overall mission and strategic plan of the organization.8. Follow organizational and departmental policies and procedures, as applicable.9. Perform related duties as assigned.

Education

• Bachelor's Degree (Required) Experience: 3 years related experienceSubstitution: May substitute Associate Degree in related field with 5 years experience for the Bachelor's degree and 3 years of experience

Credentials

• No Certification, Competency or License Required

Work Schedule: Days

Status: Full Time Regular

Location: General-MSOB

Location of Job: US:WV:Charleston

Talent Acquisition Specialist: Anita J. Ferguson