"Claims Analyst Senior"

This is a salaried (monthly pay) Professional position reporting directly to the Director of the Post Service Complex Claims Unit. This role works directly with internal and external legal counsel teams by providing all-encompassing support and tracking needed to ensure the best possible outcome of cases submitted for legal proceedings relative to Auto No-Fault and Worker Compensation cases that are not successfully collected through normal claims submission and resolution measures. This self-motivated, confident, Professional will function independently, collaboratively requiring minimal day-to-day supervision to deliver high quality product in a timely, accurate, and effective manner. Represent Michigan Medicine with confidence, using their broad knowledge of billing, collections, reimbursement rules/methodologies, regulations, and internal processes in legal proceedings.

• Gather, prepare, analyze, and review extensive documentation for all legal cases regarding Auto-No-Fault and Workers Compensation matters
• Create and maintain organized files for each legal case
• Prepare, provide and maintain extensive billing grids (excel) for accepted / active legal cases
• Monitor inventory of open legal cases
• Track outcomes of closed legal cases
• Prepare and present quarterly collections reports for legal cases for Sr Leadership; other relative reports as requested
• Review monthly Auto No-Fault payments received from No-Fault Carriers, generate and send appropriate underpayment letters
• Track outcomes of underpayment letters sent including completion and resolution of Auto No-Fault HB Variance work queue
• Prepare settlement checks for payment posting team received from legal counsel, ensure correct settlement payment application, ensure refunds are executed promptly
• Ensure prompt account closure of closed or settled legal cases by coordinating work with other Revenue Cycle departments; Credit team, Coding, CB Billing team (rebills, adjustments) Customer Service, etc.
• Review and respond to Negotiated payment request received from Auto No-Fault and/or Worker Compensation Carriers
• Research applicable laws, regulations, review medical documentation, police reports, MACP correspondence, etc.
• Share and coordinate Discovery requests with internal (OGC) and outside legal counsel on matters in litigation
• Authority to determine if cases should be presented to outside legal counsel for legal action
• Authority to confidently participate in legal facilitation discussions and negotiations with legal counsel by representing the organization in settlement hearings, depositions, trials, or other formal proceedings in person, virtually, phone, email, etc.
• Authority to determine, advise and/or approve bottom line settlement amounts impacting revenue to a substantial degree
• Provide guidance and training to staff who bill and collect Auto No-Fault or Workers Compensation claims
• Subject matter expert (SME) for legal case processes
• Identify, resolve and communicate problems and barriers to leadership
• Assure compliance with institutional and departmental goals, objectives, policies, standards and guidelines
• Demonstrate personal integrity, enthusiasm, and empathy to internal and external customer

Required Qualifications

• Bachelors degree or equivalent combination of education and experience.
• 5 years (current) Medical Billing Follow Up and Collections Accounts Receivable (professional and/or hospital) experience containing Auto No-Fault / Workmen Compensation a plus
• Fluent knowledge / use EPIC Medical Billing System platform (HB and/or PB Resolute Module)
• Working knowledge of CMS/Medicare reimbursement policies (Hospital Part A and /or Professional Part B)
• Proficient to Expert level in Excel spreadsheeting concepts with considerable experience with use of other Microsoft products (PowerPoint, Word, Outlook, etc.)
• Ability to work with / navigate large amounts of data while ensuring accuracy
• Exceptional verbal, written, and listening communication skills
• Strong independent, problem solving, investigative, analytical, critical thinking skills
• Detail oriented, excellent organization skills, self-directed
• Independently assess competing priorities, manage workflow and meet tight operational deadlines while ensuring accurate output with minimal supervision
• Demonstrated ability to work in a team environment, build trust and working relationships with legal teams, billing team members, Sr Leadership, etc.
• Ability and willingness to exhibit behaviors consistent with standards of performance improvement and organizational values (e.g., efficiency & financial responsibility, safety, partnership & service, teamwork, compassion, integrity, trust and respect)

Preferred Qualifications

• Knowledge of Michigan Medicine policies procedures
• Extensive background in Auto No-Fault / Workmen Compensation claims resolution
• Proficient/Expert knowledge and understanding of Auto No Fault Law MCL500.3157
• Proficient/Expert in Medicare Hospital and Professional reimbursement methods and concepts
• Pryor experience interacting with legal counsel / participation in legal proceedings and or depositions