Billing and Reimbursement Analyst

Title:Billing and Reimbursement Analyst

$24.19 - $30.74 / Posted Thru: 1-22-2025

Location: Hybrid - Must live and work in the state of Michigan.

Purpose: This position will handle the claims analysis, processing, and reimbursement activities for the WISEWOMAN Program and will provide customer service for participating providers and local coordinating agencies (LCAs). This position will be a backup for the Breast and Cervical Cancer Control Navigation Program (BC3NP). This position will be a member of teams which collect, consolidate, analyze, and maintain program data necessary to meet program reporting and evaluation requirements and the goals of the agency program or service. This includes but is not limited to data entry and claims review for the WISEWOMAN program and will require participation in program meetings and related communications.

• Maintain a detailed knowledge of the claims process for WISEWOMAN and for BC3NP as backup.
• Analyze weekly claim file(s) using predefined programs and audit tools to ensure accuracy of claim processing.
• Review and process requests from billing services and health care providers for clarification of client eligibility, client enrollment dates, and other requests, as necessary.
• Work with contractors to ensure requests are processed correctly by the billing service.
• Monitor and review reimbursement for all agencies/contractors and notify them of any issues that may lead to a delay in reimbursement.
• Analyze the ongoing claims reimbursement process and report any issues.
• Develop and recommend alternative strategies to address and resolve claims reimbursement issues that arise.
• Consult with contractors (via phone, fax, secure emails) regarding claim and reimbursement questions.
• Create and distribute reimbursement status reports to contractors and Direct Service staff as needed.
• Review and adjudicate state overrides for non-BC3NP CPT codes as approved by Program Nurse Consultants.
• Enter data from paper claims for providers who are unable to billelectronically.
• Enter WISEWOMAN program data asneeded.
• Consult with WISEWOMAN Intervention Consultant for questions about data forms or missing data, as needed, prior to entering in MBCIS.
• Ensure the accuracy of dataentry.
• Researchand evaluatethe annual Medicare rate updates and provide analysis to WISEWOMAN Program Director for determination of reimbursement rate changes ifapplicable.
• Maintain, update, and distribute reimbursement documentsincluding:WISEWOMAN RateSchedules andWISEWOMAN ICD-10Codes
• Maintain, update, and distribute reports pertaining to allprograms.
• Review relevant claims related reports in Business Objects and take necessary actions.
• Attend and participate in WISEWOMAN team,Data team,Cancer section, Division, and Bureau meetings.
• Attend WISEWOMAN Technical Assistance meetings with local coordinating agencies. Present new billing information and take questions
• Provide billing/reimbursement updates during WISEWOMAN team meetings.
• Maintain privacy and confidentiality of all data andinformation.
• Complete required health equity trainings and work to address health equity in routine job duties.
• As an MPHI employee, maintain a positive, strong, credible, professional, and interpersonal relationship with all parties relevant of MPHI Projects, and represent the best interests of MDHHS and MPHI at all times.
• Other duties as assigned.

Education:Possession of a bachelor's degree in any major. Certification in medical coding and billing, certified professional biller (CPB), certified professional coder (CPC) preferred.

In lieu of a bachelor's degree, candidates with a high school diploma and at least four years of professional experience in medical billing, claims processing, or reimbursement will be considered.

Experience:A minimum of three years of professional experience in medical billing, claims processing, or reimbursement. Experience in working with third- party resources such as Medicare, Medicaid, and private insurance.

Important Skills andCharacteristics:

• Must have strong knowledge of medical billing and reimbursement.
• Must have expertise with Microsoft Excel and experience using database software.
• Strong organization and computer skills including Microsoft Office required.
• Must have effective oral and written communication, presentation, and problem-solving skills.
• Ability to organize and present information effectively.
• Ability to analyze and assess reimbursement operations and recommend alternative strategies to increase the efficiency of operations.
• Ability to learn and use unfamiliar computer applications.
• Must be self- motivated, able to complete work in a timely manner, and able to handle multiple tasks at one time with minimal supervision.
• Ability to be comfortable functioning in a diverse team environment.

WorkEnvironmentandPhysicalRequirements:Job may require moderate physical effort including lifting materials and equipment of less than 50# and involves viewing a computer monitor 25% to 75% of the time. Standard office environment. This is a hybrid position. This position may work remotely after successful training that will require time in the Lansing Office. Following training, regular Lansing Office hours will be on Tuesday and Thursday, with the option to work remotely other days. Requires valid vehicle operator's license where needed to perform duties of the position.

IMPACT ONPROJECTS,SERVICES AND OPERATIONS:This position performs duties and responsibilities on behalf of the Michigan Department of Health and Human Services as an employee of MPHI. This Departmental Analyst position will function as a member of the MDHHS Cancer Prevention and Control Section team which plans, implements, and evaluates statewide programs designed to reduce mortality and morbidity due to cancer and other chronic diseases. This position will impact the timely and accurate processing of payment of claims submitted by providers participating in the WISEWOMAN and BC3NP Programs. This position will have an impact on the security and integrity of the data system used by WISEWOMAN and BC3NP for billing and reimbursement, grant data reporting, and quality improvement. The work of this position will be done in a manner that is consistent with policies and procedures to ensure the privacy and confidentiality of protected health information (PHI), personally identifiable information (PII), and other sensitive information at MDHHS and MPHI.

For purposes ofemploymentstandards,thisclassificationis"Non-Exempt"fromovertimeprovisions of thefairLaborStandardsAct.