DescriptionThe Senior Provider Reimbursement Professional performs research, analysis, documentation, and interpretation for the provider reimbursement programs for an organization that provides health insurance. The Senior Provider Reimbursement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Senior Provider Reimbursement Professional 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. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
• Understands industry and Humana claim coding and claim processing
• Skilled in analyzing data against expected outcomes to determine accuracy and issue root cause
• Develop and communicate actionable and clear insights for customers’ transactional request
• Able to prepare concise and meaningful data presentations in excel using simple graphical presentations
• Use appropriate problem-solving, research and analysis tools to collect, analyze and synthesize quantitative and qualitative data and information
• Bachelor’s Degree or 5+ years of medical claims experience
• Healthcare experience (provider or payer)
• High school diploma or equivalent
• Proficient in Excel
• Demonstrable expertise and ability to translate data into simple customer message
• Demonstrated ability to identify root cause and corrective actions
• Proven ability to drive self to achieve commitments
• Strong written and verbal communication skills
• Certified coding specialist - AHIMA, certified outpatient coder - AAPC, or certified professional coder - AAPC
• Experience in data management, data extraction and data reporting
• Financial analysis experience
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours40