Position Summary:

• Secures pre-admission approvals from third party payors prior to appointment scheduling.
• Negotiates letters of agreement with non-contracted third party payors.
• Develops and implements systems to analyze reimbursement accuracy. Monitors payor compliance with contractual agreements to ensure reimbursement is received according to the stipulated terms.
• Coordinates and communicates status of patient’s admission with managed care, admissions, patient financial services, case management and CAMP staff.
• Serves as the primary contact person for CAMP related financial matters including resolving issues with third party payors, family/patient billing concerns and internal reporting.
• Analyzes charge trends across Children’s Memorial Hospital’s multi-specialty group practice to identify missing revenue or any opportunity for revenue enhancement.

Knowledge, Skills and Abilities:

• Bachelor’s degree in business or related field is required. Masters degree preferred. A combination of education and/or experience may be considered in lieu of the degree when the experience has been directly related to the duties of the job.
• Two years of experience in negotiating and contracting with third party payors.
• Strong organizational, interpersonal and customer service skills.
• Strong communication, writing, presentation, and analytical skills required.
• Prior experience on coding, billing in a clinical setting strongly preferred.
• Demonstrated knowledge of Word and Excel and PowerPoint.
• Familiarity with hospital and physician billing, reimbursement methodologies and third party regulations.
• Working knowledge of financial statements and ability to analyze financial information in order to determine financial impact of possible changes.
• Prior experience working in direct contact with patients and families.
• Working knowledge of hospital information systems to include electronic claims editing software and patient accounting systems preferred.