Career Center

Medical Reimbursement Configuration Analyst

Location: Remote
Posted On: 11/23/2021
Requirement Code: 52633
Requirement Detail

Required :


Staffing Technologies has partnered with a keystone business located in Portland, Oregon!  With a people first business model and a culture of volunteerism, this robust business provides a nurturing, inclusive and stable work environment to grow with for the long-term. Offering products that support and sustain healthy living, this established business operates in 6 states with plans for future expansion. As a Reimbursement Configuration Analyst, you'll have the opportunity to play a critical role with the business to ensure the insurance products that they sell, and deliver are configured accurately.  You'll partner with the sales, claims department, and customer service teams to ensure a seamless medical provider experience. 

 

The Medical Reimbursement Configuration Analyst performs provider pricing configuration of low to moderate complexity; evaluates, designs, tests and performs configuration needed to meet the business requirements for provider contracts, with a substantial variety of pricing methodologies including CMS, DRG, APC, Medicaid, RBRVS etc.; assures end results achieve the highest levels of accuracy and claims auto adjudication.

 

The Medical Reimbursement Configuration Analyst performs provider pricing configuration of low to moderate complexity; evaluates, designs, tests and performs configuration needed to meet the business requirements for provider contracts, with a substantial variety of pricing methodologies including CMS, DRG, APC, Medicaid, RBRVS etc.; assures end results achieve the highest levels of accuracy and claims auto adjudication.


Primary Functions:

 

- Analyzes provider contracts for institutional and non-institutional providers, developing business requirements.

- Analyzes pricing business requirements, develops and evaluates alternatives, prepares proposals and design specifications for complex configuration systems or applications to meet the identified needs, goals and metrics.

- Configures and tests results, assuring that the highest levels of quality and claims auto adjudication are met.

- Consults with Provider Contracting and/or Analytics to determine appropriate interpretation of contract intent.

- Works with varying and low to moderate complexity pricing methodologies including, but not limited to, Medicare and Medicaid methodologies, Medicaid, DRG, APC, Outliers, RBRVS, Fee Schedules etc.

- Designs and creates qualifiers within the system to assure appropriate services are priced at the correct rates.

- Evaluates provider set up and works with Provider Data Maintenance team to assure that pricing and provider data are in synch.

- Researches and resolves issues of low to moderate complexity that are referred from Claims, Customer Service, Provider Relations, Credentialing, Analytics and Appeals.

- Represents the unit on projects as assigned.

- Attends software vendor subcommittee meetings to further knowledge and keep aligned with system changes and solutions.

- Other duties as assigned.

 

Required Skills:

 

- Bachelor's degree in computer science or healthcare related field, or equivalent work experience

- Minimum 1-3 years' experience in the health insurance industry, with a strong medical claims background preferred

- Minimum 2-4 years' experience in pricing configuration, preferably in Facets and NetworX

- Proficient in interpretation and analysis of provider contracts

- Proven ability to translate provider contracts of low to moderate complexity into pricing configuration

- Experience with configuration lifecycle of analysis, design, configuration, testing and implementation is preferred

- Proven problem solving and troubleshooting skills, employing ?€?outside the box?€? thinking

- Strong MS Excel skills are required

- Demonstrated knowledge of pricing methodologies, including but not limited to Medicare and Medicaid, DRG, SNF, RBRVS, APC etc.

- Ability to clearly document processes

- Strong knowledge of medical coding and experience is required, which could be acquired through extensive medical claims processing background

- PC proficiency with Microsoft office applications and Outlook

- Ability to work well under pressure with frequent interruptions and shifting priorities

- Ability to maintain confidentiality, and project a positive and professional business image

- Ability to come to work on time daily

- Ability to work independently, with minimal supervision