logo

View all jobs

Senior Reimbursement Analyst

Rego Park, NY · Accounting/Finance
About the Company: 
A Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored healthcare programs, focusing on underinsured and uninsured individuals.  Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs, and Medicare (Special Needs Plans).  

The Company operates local health plans and offers a range of health insurance solutions.  It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.


Position Overview: Develop and recommend provider reimbursement standards, policies, and guidelines that align with industry standards and state requirements. Serve as the key liaison between health plan network management, finance and contract implementation and configuration for reimbursement processes.


Responsibilities: 
  • Research and analyze provider reimbursement methodologies and regulatory medical coding requirements to ensure alignment with state requirements.
  • Develop and maintain fee schedules as required by the state.
  • In collaboration with Finance, conduct impact analysis related to fee schedules or payment policy changes.
  • Serve as primary contact to the state for all provider reimbursement methodology issues.
  • Identify technological solutions to implement alternative payment solutions to improve cost and contract performance.
  • Develop standardized reimbursement payment solutions to improve, manage and predict unit cost performance
  • Oversee entire project life cycle, including deliverables, resource allocations, and implementation.
  • Develop improvement processes and methods used to implement new provider reimbursement for the business unit.

Qualifications:
  • Bachelor’s degree in Business Administration, Healthcare Administration, or related field or equivalent experience.
  • 5+ years of provider reimbursement and analysis experience.
  • Experience with Medicare and Medicaid reimbursement methodology.
  • Managed care experience and provider billing experience preferred.
Ellen M. McWade
ProEnlist, LLC
Connect with me on LinkedIn
Follow ProEnlist for More Jobs
ProEnlist on Glassdoor
ProEnlist on Facebook

Please do NOT email the recruiter.  Applications are only accepted via the apply link.
C2C Not Available for This Position

 
Powered by