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Provider Reimbursement Policy Specialist Sr
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Job Description
- Req#: 43631
Employer Industry: Healthcare Solutions
Why consider this job opportunity:
- Flexible work solutions including remote options and hybrid work schedules
- Competitive pay with comprehensive benefits including health insurance coverage starting on Day 1
- Paid time off, including holidays and opportunities for volunteer events
- 401(k) plan and tuition reimbursement available
- Opportunity to impact the lives of millions through comprehensive healthcare solutions
- Chance to work within a mission-driven organization focused on building healthier communities
What to Expect (Job Responsibilities):
- Create and maintain standardized documentation for medical and clinical claim payment policies and edits
- Research and advise on medical coding including CMS, AMA/CPT, HCPS, and ICD-10
- Act as a liaison between Payment Integrity vendors and internal business teams to implement and troubleshoot medical policy reimbursement
- Assist in the development and implementation of new claim reimbursement edits and coordinate testing with outside vendors
- Mentor and train Medical Policy Specialists
What is Required (Qualifications):
- Associate's Degree or equivalent experience in Medical Policy and Reimbursement Claim Edits
- Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or Certified Professional Coder-Hospital (COC)
- Minimum of 10 years in Claim Auditing, Claims Billing, Medical Loss Review, or related positions in a medical facility or managed care organization
- Minimum of 10 years in a Business Analyst role within a medical insurance carrier operations team
- Strong experience with Medicaid, Medicare, and Commercial Insurance
How to Stand Out (Preferred Qualifications):
- Expert skills utilizing Microsoft Office programs; experience with SharePoint, MS Access, or SQL is a plus
- Ability to work effectively with all levels of staff from Analysts to Senior VPs
#HealthcareSolutions #MedicalPolicy #RemoteWork #CareerGrowth #HealthcareCareers
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