Data Quality & Reimbursement Consultant

Position Summary: The Data Quality and Reimbursement Consultant’s primary responsibility is to read, interpret, and analyze contracted payer documents. The consultant is expected to stay current on healthcare regulations from the Centers for Medicare and Medicaid Services (CMS), as well as other payment systems. This position works independently, though, often collaborates with various teams. The consultant reports to the Director of Data Quality & Reimbursement.

Position Site: Hybrid, In-office 3 days per week

Travel Requirements: No travel required

Principal Responsibilities:

Procedure Pricing and Payment Studies

Contract Modeling

• Read, interpret, provide analysis on payer contract terms, and apply this information to the data for strategic pricing and/or payment assessment projects
• Offer consulting services to client when necessary concerning contract modeling results for comparison of terms
• Review result data for accuracy, reasonableness, and completeness
•  Effectively communicate with client to obtain necessary information to complete various stages of project

Other/Miscellaneous

• Represent the team to answer questions and describe the contract modeling process during client-project scoping discussions
• Complete contract comparison to benchmark the client managed care/commercial contract reimbursement terms against terms of similar providers
• Develop payer to contract mapping connection file to complete contract modeling process
• Document project information in organization’s project management system
• Analyze Charge Description Master (CDM) data, when needed

Special Projects

• Conduct contract testing preparation and support
• Performing quality, billing, or coding related projects outside of primary pricing/payment projects
• Respond to healthcare data or information questions as requested by other C+A staff members
• General DQRC team support, when needed
• Other requests as necessary to fulfill the C+A vision, purpose, and principles

Committee Participation

Engage in C+A organization-wide committee efforts and collaborate with other departments to enhance company objectives

Professional Development

• Engage in educational opportunities to enhance knowledge, skill, and application abilities
• Must meet certification/credential requirements or at a minimum 20 hours per year
• Professional Volunteer Participation- OPTIONAL
• Participate in volunteer role of choice with a professional organization related to the C+A vision, purpose, and principles

Education:  

• Bachelor’s Degree in Health Information Management & Systems, or a related degree
• AHIMA, HFMA, or related professional certification required

To be obtained within six (6) months of hire

o  RHIA certification recommended

Experience:

• Considerable knowledge in the health information field and revenue cycle, working with healthcare data, and/or healthcare reimbursement
• Two to four years of industry or relevant health administration experience, preferred

Knowledge, Skills & Abilities:

• Knowledge and Experience with Chargemasters, Reimbursement, Coding/Billing, and provider pricing
• Proficient in Microsoft Office: Outlook, Word, Excel, Access
•  Strong critical thinking, problem solving, and analytical skills
• Demonstrates a strong customer service effort, external and internal, with proven ability to resolve business challenges creatively
• Attention to detail with solid organizational skills
• Self-motivated
• Detail-oriented
• Exercise leadership skills from any role
• Exceptional verbal and written communication skills
• Feedback abilities to communicate effectively, respectfully, and constructively as well as accepting to receive same nature of communication
• Team focused with quality project results by expected deadline goal
• Time management mastery: ability to manage multiple projects at once
• Support a high standard of quality assurance, including creating, implementing, and maintaining data quality control processes
• Ability to manage project deadlines effectively.
• Commitment to meeting project deadlines, be flexible, and adapt to an ever-changing environment
• Continuous interest in personal and professional development

Sensitive Data Access:  The Data Quality and Reimbursement Consultant will need to access client Confidential and Protected Health Information (PHI). This may include client contracts and claim data files. Although this position requires access to Confidential and Protected Health Information, they will only access the information when it is absolutely necessary to perform their duties.

About: 

Started in 2000, we are a privately-owned consulting and analytics company headquartered in Columbus, Ohio, that partners with hundreds of hospitals each year to address today’s most challenging questions in pricing, payment, and financial performance for the US hospital industry.

We help hospitals provide value to their communities. We acquire, standardize, and aggregate a variety of hospital financial and operational data. Leveraging these data sources, we provide custom consulting and advisory services primarily focused on revenue cycle, budgeting, decision support, and finance operations. Specifically, we aim to help make hospital prices more reasonable, hospital reimbursement easier to understand and manage, and data more actionable.

We provide a flexible, family-friendly work environment, comprehensive health benefits (including Medical, Dental, Vision, Life/Disability Insurance, HSA, and HRA), 401(k), profit sharing, and paid time off.

Cleverley + Associates makes employment decisions based upon abilities, talent, effort, team attitude, and results. We grant equal employment opportunity to all qualified individuals without regard to race, color, religion, sex, national origin, age, ancestry, citizenship, disability, sexual orientation, or other protected class status.

Candidates for this position must be employable in the United States without sponsorship.

If you are interested in applying for this position, please send your resume, references, and relevant work examples to careers@cleverleyassociates.com.