Senior Provider Reimbursement Analyst (43439)

The Senior Provider Reimbursement Analyst is responsible for development and management of fee schedules, including sample schedules, and alternative payment methodologies (APM) that support strategic and corporate goals. This position develops provider reimbursement mechanisms using industry standards and in alignment with state and corporate financial initiatives and recommends areas for optimization.

Requirements

• Bachelor's degree in Mathematics, Finance, Economics or a related field
• Five years' experience with a managed care organization or a health care related organization
• Three to five years' experience in provider reimbursement and Alternative Payment Methodology financial modeling
• Advanced skills in Microsoft Office suite, specifically in Excel
• Demonstrated understanding and experience in data analytics, provider reimbursement mechanisms, such as Medicare reimbursement methodologies, fee-for-service, per diem, case rate, Diagnosis-Related Groups (DRG), Ambulatory Payment Classification (APC), Ambulatory Surgery Center (ASC), and Resource Utilization Group (RUGs)
• Demonstrated understanding of contractual language, health insurance; insurance laws and regulations, including Medicare and Medicaid policies; claims processing; medical and insurance terminology
• Knowledge of CMS, Federal and State laws and requirements and other applicable industry standards and benchmarks