Provider Reimbursement I - Business Project Management Consultant
Responsible for the support and administration of provider reimbursement methodologies for negotiated reimbursement arrangements across provider systems. Partner with Network Management and other areas of the organization to manage reimbursement process by providing implementation and ongoing maintenance support and direction on technical and business processes.
- Develop and maintain provider fee schedules/internal benchmarks using knowledge of standard external benchmarks and proprietary pricing strategies.
- Utilize commercial and Medicare reimbursement methodologies, monitor market reimbursement trends and federal reimbursement regulations, and data management/analysis.
- Maintain a current working knowledge of processing rules, contractual guidelines, state/Plan policy and operational procedures to effectively provide technical expertise and business rules
- Serves as the subject matter expert in reimbursement methodologies (industry and health plan), rules and provider billing requirements.
- Provide support to Network Contracting, Product, Payment Integrity, Legal, Internal Audit, Revenue Program Management and other internal departments related to reimbursement methods, fee schedules, policies, and Medicare.
- Operational activities including fee schedule/price rules maintenance activities, provider appeals, response to internal/external questions, research, and analysis.
- Bachelor’s degree or equivalent work experience
- 6+ years related work experience or equivalent combination of transferrable experience and education
- Experience in Healthcare industry, with a focus on reimbursement methodologies(i.e., fee for service, capitation, DRG, per diem, etc.)
- Knowledge of healthcare billing, claims processing, claims pricing, CPT/HCPC codes, provider payments and CMS policies
- Demonstrated ability to achieve business results in an environment of ambiguity, challenge and constantly changing business needs
- Must be able to communicate highly detailed and technical information in a concise and understandable way to all levels of the organization
- Advanced level proficiency of Microsoft Office (Word, Excel and Outlook)
If you believe that your skills and experience are a match for this position, please give us a call at 904-998-9414 to speak to a Recruiter, e-mail your most current resume to email@example.com or apply on line at https://jobs.btginc.com
Job Status: Full Time