DescriptionThe Provider Reimbursement Professional 2 performs research, analysis, documentation, and interpretation for the provider reimbursement programs for an organization that provides health insurance. The Provider Reimbursement Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Provider Reimbursement Professional 2 updates, maintains, and reviews fee scheduling and pricing structures. Ensures contracted rates and reimbursement policies are priced and applied accurately. Identifies reimbursement policy and process recommendations and ensures compliance with government regulations. Analyzes provider reimbursement patterns and trends. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
- Bachelor's degree or equivalent combination of education and experience.
- Ability to work independently and apply critical thinking, self-driven, flexible with change
- Demonstrated competency in both oral and written communication skills.
- Claims processing knowledge (3+ years)
- Strong research and collaboration skills
- Strong research, problem-solving, analytical and negotiation skills
- Strong computer skills including MS Office applications (Word, Excel, PowerPoint)
- Strong written and verbal communication skills
- Solid understanding of process / work flow concepts
- Master’s Degree in Business, Finance or related fields
- Experience writing/implementing policies
- Healthcare Insurance Industry knowledge
- Previous experience working with/for Regulatory Compliance Department
- Coding knowledge (CPC preferred, but not required)
- Registered Nurse (RN)
Scheduled Weekly Hours40