Job Details

Serve as subject matter expert on payer contracts, reimbursement policies, and UB-04 claim guidelines. Subject matter expert with contract language. Expert in contract interpretation and contract language application to accounts receivable and issue identification. Expert in UB-04 claim editor guidelines, timely/appeal guidelines, CMS guidelines, and payer reimbursement processes to ensure accountability and compliance. Expert in calculating expected reimbursement based on charges billed on UB-04 forms and the negotiated contract between the payer and Dignity Health, applying all terms and considerations, including CMS guidelines and payer policies. Solid ability to identify and validate poor payer behavior, analyze accounts receivable and applying contract, policy and provider manuals to strengthen rebuttal against payer. Create trending payer projects. Manage payer escalations, litigation support, bankruptcies, and settlements from start to finish. Prepare and deliver professional pr...Director, Solutions, Solution, Remote, Microsoft, Project Management, Technology, Healthcare