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Signature Performance, Inc. · 1 day ago

Payer Payment & Reimbursement Analyst

United States

Full-time

Remote

Mid Level

3+ years exp

Signature Performance, Inc. is dedicated to lowering healthcare administrative costs for federal government agencies, payers, and providers. They are seeking a Payer Payment & Reimbursement Analyst to perform system configuration tasks related to contracts, pricing, and reimbursement for healthcare claims, while analyzing vendor bulletins and healthcare data sets for compliance and updates.

Health Care

Growth Opportunities

Responsibilities

Perform system configuration tasks related to contracts, pricing and reimburse for healthcare claims

Review and analyze related vendor bulletins and updates for applicability and/or changes to internal process, product or data systems

Review and analyze healthcare data sets for applicability and/or changes to changes to internal process, product or data systems

Read and analyze Medicare, VA, CHAMPVA, TRICARE data and policy including rulings, directorates, transmittals, bulletins, policy manual updates, physician fee schedule (data file)

Contact various government entities to clarify new and existing policy

Interpret and deliver business requirements covering reimbursement updates and payment policy changes and enhancement features for translation into software design specifications

Create detailed excel formulas to explain and prove complex payment methodologies

Identify claim data characters for testing of pricing configurations

Coordinate with developers, QA, data, client service and other team members to ensure that business requirements are implemented accurately and timely

Develop test claims for Developers, UAT and QA

Perform configuration testing

Develop and maintain proficiency in the Company's products (software, data) and services, including commercial contracting features as related to the specific area(s) assigned

Experience working in the healthcare system with working knowledge of billing, compliance, and payer reimbursement guidelines/regulations

Ability to evaluate complex pricing issues for resolution

Ability to work independently and prioritize workload according to project goals and objectives

Core competencies include analytical thinking, information seeking, concern for quality, teamwork

Qualification

Payer Payment AnalysisHealthcare Reimbursement SystemsClaims Adjudication KnowledgeSQL ReportingExcel FormulasAmbulatory Payment ClassificationsDiagnosis Related GroupsTriZetto FacetsOptum Rate ManagerAnalytical ThinkingInterpersonal SkillsTeamworkProblem-Solving Skills

Required

3-4 years professional experience in provider payment/reimbursements for healthcare, and familiarity with health care reimbursement systems and methodologies

Experience working in the healthcare system with working knowledge of billing, compliance, and payer reimbursement guidelines/regulations

Experience in healthcare provider professional and institutional payment and reimbursement fee schedules (such as AWP, Physician Fee, DME/DEMPOS, Ambulance, Lab, ESRD, Hospice, Dental, ASC, Anesthesia)

Experience working with Prospective Payment Systems, including (Acute Inpatient, Hospital Outpatient, Skilled Nursing, Home Health, Long-Term Care, Inpatient Rehabilitation, Inpatient Psychiatric)

Knowledge of Ambulatory Payment Classifications (APCs)

Knowledge of Diagnosis Related Groups (DRGs)

Knowledge of the integrated Outpatient Code Editor (I/OCE) program

Able to collect, research, and understand diverse information, and translate it into clear and concise written requirements

Able to plan, prioritize, and balance the need for direction with self-motivated efforts

Strong interpersonal skills

Working knowledge of provider types and specialties, including the applicable fee schedule or reimbursement payment methodology for the provider type

Ability to effectively communicate and collaborate with diverse internal and external stakeholder groups and individuals