Job Description
Note: The job is a remote job and is open to candidates in USA. Tennova Healthcare - North Knoxville Medical Center is a leading healthcare provider committed to helping people get well and live healthier. The Payment Compliance & Contract Management (PCCM) Analyst will maximize reimbursement by analyzing contract compliance and collaborating with teams to improve revenue cycle processes. Responsibilities • Analyzes contract reimbursement, identifying variances, trends in underpayments/overpayments, denials, and revenue leakage to support maximization of reimbursement. • Manages underpayment appeals and account follow-up, working collaboratively with payers and internal teams to resolve discrepancies in a timely manner. • Interprets contract terms, validates compliance, and provides feedback to management and departments to ensure accurate reimbursement processes. • Compiles, analyzes, and presents data on payment trends, making recommendations for improvements in revenue cycle processes. • Reviews payer policies and updates for their impact on reimbursement, communicating changes to appropriate teams to ensure compliance. • Develops and maintains reports that identify payment discrepancies, revenue opportunities, and performance metrics for management review. • Collaborates with financial, clinical, and operational teams to address contract compliance issues and enhance payer relations. • Maintains knowledge of medical coding systems, reimbursement structures, and regulatory changes to support accurate account adjudication. • Performs other duties as assigned. • Maintains regular and reliable attendance. • Complies with all policies and standards. Skills • H.S. Diploma or GED required • 2-4 years of experience in revenue cycle management, contract compliance, or healthcare reimbursement analysis required • Strong understanding of managed care, government contracts, and reimbursement processes. • Proficiency in data analysis, with the ability to compile and interpret complex data sets related to contract compliance and payment trends. • Excellent communication and interpersonal skills for working with internal teams and external payer representatives. • Knowledge of medical coding systems (ICD-10, CPT, HCPCS, DRG, etc.) and how they affect claim adjudication. • Strong organizational skills, with the ability to manage multiple projects and deadlines. • Proficient in Google and Microsoft Office Suite, with intermediate to advanced Excel skills. • Associate Degree or higher preferred Benefits • Medical, dental and vision, insurance • 401k Company Overview • North Knoxville Medical Center is an acute care hospital. It was founded in undefined, and is headquartered in Powell, Tennessee, US, with a workforce of 501-1000 employees. Its website is Apply tot his job