Provider Reimburse Admin (US)
About the position
The Provider Reimbursement Admin plays a crucial role in ensuring the accurate adjudication of claims by translating medical, reimbursement, and clinical editing policies into effective reimbursement criteria. This position involves reviewing various medical policies, conducting research, and analyzing data to support the development and revision of enterprise reimbursement policies.
Responsibilities
Ā Reviews company-specific, CMS-specific, and competitor-specific medical policies, reimbursement policies, and editing rules.
,
Ā Conducts clinical research, data analysis, and identifies legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
,
Ā Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
,
Ā Coordinates research and responds to system inquiries and appeals.
,
Ā Conducts research of claims systems and system edits to identify adjudication issues and audits claims adjudication for accuracy.
Requirements
Ā Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience that provides an equivalent background.
,
Ā American Academy of Professional Coders (AAPC) CPC, CEMC or American Health Information Management Association (AHIMA): RHIA, RHIT, CCS, CCS-P coding certification is required.
Nice-to-haves
Ā Proficiency in Microsoft Word, Excel and SharePoint.
,
Ā EM Leveling audit experience preferred.
,
Ā Strong research skills and ability to perform well independently and in a team setting.
,
Ā Experience working in a production environment with short timelines is strongly preferred.
,
Ā Knowledgeable of the application of Medicaid, Medicare or Commercial reimbursement policies and guidelines.
,
Ā FACETS or WGS experience preferred.
Benefits
Ā Merit increases
,
Ā Paid holidays
,
Ā Paid Time Off
,
Ā Incentive bonus programs
,
Ā Medical benefits
,
Ā Dental benefits
,
Ā Vision benefits
,
Ā Short and long term disability benefits
,
Ā 401(k) with matching
,
Ā Stock purchase plan
,
Ā Life insurance
,
Ā Wellness programs
,
Ā Financial education resources
Apply Now
The Provider Reimbursement Admin plays a crucial role in ensuring the accurate adjudication of claims by translating medical, reimbursement, and clinical editing policies into effective reimbursement criteria. This position involves reviewing various medical policies, conducting research, and analyzing data to support the development and revision of enterprise reimbursement policies.
Responsibilities
Ā Reviews company-specific, CMS-specific, and competitor-specific medical policies, reimbursement policies, and editing rules.
,
Ā Conducts clinical research, data analysis, and identifies legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
,
Ā Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
,
Ā Coordinates research and responds to system inquiries and appeals.
,
Ā Conducts research of claims systems and system edits to identify adjudication issues and audits claims adjudication for accuracy.
Requirements
Ā Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience that provides an equivalent background.
,
Ā American Academy of Professional Coders (AAPC) CPC, CEMC or American Health Information Management Association (AHIMA): RHIA, RHIT, CCS, CCS-P coding certification is required.
Nice-to-haves
Ā Proficiency in Microsoft Word, Excel and SharePoint.
,
Ā EM Leveling audit experience preferred.
,
Ā Strong research skills and ability to perform well independently and in a team setting.
,
Ā Experience working in a production environment with short timelines is strongly preferred.
,
Ā Knowledgeable of the application of Medicaid, Medicare or Commercial reimbursement policies and guidelines.
,
Ā FACETS or WGS experience preferred.
Benefits
Ā Merit increases
,
Ā Paid holidays
,
Ā Paid Time Off
,
Ā Incentive bonus programs
,
Ā Medical benefits
,
Ā Dental benefits
,
Ā Vision benefits
,
Ā Short and long term disability benefits
,
Ā 401(k) with matching
,
Ā Stock purchase plan
,
Ā Life insurance
,
Ā Wellness programs
,
Ā Financial education resources
Apply Now