Provider Reimbursement Specialist
Develop, implement, and maintain multiple reimbursement system(s) and complex methodologies (hospital, value based, capitation, etc) for different provider types (e.g., participating physicians/groups, hospitals, ancillary providers, etc). Accountable for review, analysis and implementing processing systems enhancements, and recommendations of business solutions. Also assists with quantitative and qualitative analysis to detect issues and recommend viable solutions.
Essential Job Functions:
- Display and deploy advanced analytic skillset and techniques to acquire, transform and translate large and complex datasets to identify report, communicate and resolve trends, risks, outliers, and unexpected patterns.
- Process and monitor complex and highly detailed end-to-end reimbursement files through multiple system integration points and applications.
- Act as subject matter expert in design, support, build and maintenance ownership of complex reimbursement arrangements.
- Through advanced independent analysis, recommend and implement process and system enhancements to provide detailed assessments, reports and resolutions related to reimbursement strategies.
- Collaborate with key business and IT resources to validate data integrity through complex system queries and accelerated business acumen.
- Manage, monitor and mitigate risk and report on progress of systems and reporting projects
- Bachelor’s degree or equivalent work experience
- 5+ years related work experience or equivalent combination of transferrable experience and education
- Experience in healthcare industry, with a focus on provider payment programs and policy
- Demonstrated ability to mine, generate and analyze complex provider reimbursement data.
- Demonstrated ability to manage multiple projects independently with a high level of critical thinking
- Highly collaborative with a demonstrated ability to build strong, credible relationships and teams within all levels in the organization
- Demonstrated audit and issue resolution skills
- High level of experience with Microsoft Excel (including pivot tables, queries, etc.)
If you have any questions, please call 904-998-9414 and reference Provider Reimbursement Specialist I position.
Job Status: Full Time