RCM Associate Contract Modeler

InfuSystem is a leading national health care service provider, facilitating outpatient care for durable medical equipment manufacturers and health care providers by delivering ambulatory pumps and supplies, along with related clinical, biomedical and billing services, to practices and patients nationwide. With a comprehensive suite of services, InfuSystem improves clinician access to quality medical equipment and promotes patient wellness and safety while reducing the overall cost of infusion care.

InfuSystem offers Oncology, Pain Management and Wound Care therapies, including Negative Pressure Wound Therapy. The company’s Durable Medical Equipment (DME) Services are composed of direct payer rentals, pump and consumable sales, and biomedical services and repair, including on-site and depot services. InfuSystem provides the sale, rental, lease and associated supplies, including infusion pumps, nerve blocks for acute pain, nerve block catheters, postoperative pain pumps, central venous catheters, IV pumps, pole-mounted pumps, syringe pumps, enteral pumps, Huber needles, clean room supplies, IV extension tubing, pump tubing, ambulatory pumps, replacement pumps, disposable products, central venous access devices, closed system transfer devices, negative pressure wound therapy vacs, wound vac, and chemotherapy and oncology infusion pumps. Biomedical services include both on-site and depot preventive maintenance, repair and warranty services, ranging from equipment inspections to extensive repairs, including compression device systems, defibrillators, EKG machines, electrosurgical units, external pacemakers, humidifiers, infusion pumps, LCDs, light sources, modules, patient monitors, printers, pulse oximeters, telemetry transmitters and tourniquets – all completed to factory specifications.

Headquartered in Rochester Hills, Michigan, InfuSystem delivers local, field-based customer support and operates Centers of Excellence in Michigan, Kansas, California, Massachusetts, Texas and Ontario, Canada.

SUMMARY:

Under the direction of the Director, RCM, the RCM Associate Contract Modeler is responsible for modeling contracts, loading and maintaining payer terms in HDMS and NikoHealth. This role includes loading, analyzing, and maintaining reimbursement rates in HDMS and NikoHealth. Additional responsibilities include maintaining HDMS tables, NikoHealth payer and billing structure, and supporting other internal teams with reimbursement-related concerns.

IN THIS ROLE, THE IDEAL CANDIDATE WILL:

• Assist with identifying payer issues and payment inconsistencies through reimbursement analysis processes.


• Has the ability to extract and interpret data from databases and reports.


• Ability to work both independently and with other departments on projects to gather data and provide meaningful findings.


• Update rejection codes monthly, or more frequently if necessary.


• Update Medicare and Medicaid reimbursement rates quarterly or on an as needed basis.


• Assist with payment analysis and update payer allowables multiple times per year.


• Payer additions and updates as requested by departments or required by payer changes.


• Create and maintain billing codes, procedure groups, allowable groups, etc. as needed.


• Load new payers or update existing payers according to contract terms.


• Remain up to date on payer medical policy notices and changes.

THE IDEAL CANDIDATE WILL HAVE THE FOLLOWING QUALIFICATIONS:

• Minimum two to five years of healthcare-related experience; or equivalent combination of education and experience.


• Strong problem solving and analytical skills.


• Demonstrates a high level of critical thinking.


• Strong time management skills.


• Strong attention to detail.


• Ability to independently meet tight deadlines in a project-based atmosphere.


• Strong organizational skills, including project planning and time management.


• Ability to work on various assignments simultaneously.


• Communicates effectively both verbally and in writing.


• Understanding of insurance guidelines including Medicare, Medicaid, Workers Compensation, and all Commercial managed-care plans.


• Familiarity with healthcare reimbursement methodologies, ICD-10, CPT, and HCPCS codes.


• Knowledge of HDMS, NikoHealth, and Waystar‘s clearinghouse and claims management tools.   

PERSONAL AND PROFESSIONAL ATTRIBUTES:

The ideal candidate must be a rigorous analytical thinker and problem solver with the following professional attributes:

• Strong work ethic


• Sound judgment


• Proven written and verbal communication skills


• Natural curiosity to pursue issues and increase expertise


• Passionate about InfuSystem and serving customers and patients


• Strives to make an impact on improving our business processes and results


• Exemplary honesty and integrity


• Ability to collaborate effectively and work selflessly as part of a team

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

COMPREHENSIVE BENEFIT PACKAGE:

At InfuSystem, we give our employees the tools to succeed both on and off the job. Our generous benefits package provides comprehensive coverage to help you protect your health and earning power and prepare for the future. In addition, we offer perks and programs that help you grow in your career and make InfuSystem a great place to work!   

• Health plan options that include an employer contribution


• Health Savings Account (HSA)


• Healthcare and Dependent Care Flexible Spending Accounts (FSA)


• Dental and Vision premiums covered by InfuSystem


• Life Insurance, STD & LTD


• Paid Parental Leave


• Adoption and Fertility Assistance


• 401(k) with a specified Company Match


• Employee Stock Purchase Program


• Tuition Assistance


• Generous Paid Time Off plan


• Employee Assistance Program


• Competitive Pay


• Employee Referral Bonus