FinThrive · 13 hours ago

Government Programs Specialist

United States

Full-time

Remote

Mid Level

3+ years exp

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Responsibilities

Research and interpret federal and state regulations (Medicare, Medicaid, Tricare, ChampVA, Workers Compensation, and/or 3M pricing products) quarterly, annually, and as updates occur to determine what reimbursement has changed, inactivated, or added since previous updates were made to pricing

Check for regulatory updates on a weekly basis, at a minimum, for assigned documentation

Download and analyze reimbursement changes required

Analyze, load, and modify fee schedules, rates, and factors included individual hospital updates

Update minimum of 10 fee schedules monthly

Perform database design, development, and enhancement, as well as manage and coordinate changes to the existing pricing systems

Create test plans and execute quality assurance on newly developed or enhanced logic

Serve as backup to vendor deploy manager learning all components of that process

Successfully engage in multiple development initiatives simultaneously

Attend customer meetings as required as government pricing reimbursement subject matter expert

Review and analyze claims (protected health information – PHI) with customers to understand pricing issues identified

Update pricing logic and provide detailed specifications to the development team for pricing node changes

Respond to customer Salesforce cases in a timely manner based on documented policy

Research and close minimum of 30 Salesforce cases per month subject to volume received

Follow up verbally with customers as needed

Communicate with government agencies

Provide internal and external customer support from implementation to full adoption of Contract Manager or any other impacted solution

Promptly report data entry and data display issues to the team supervisor or manager

Actively participate in departmental and company-wide meetings

Adhere to all departmental and company-wide policies and procedures

Cross-train in other Government Programs as needed

Attend and present at internal meetings

Attend training to maintain industry knowledge

Qualification

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U.S. healthcare experienceFederal pricing analysisMedicaid claims billingMedicare claims billingMS Office proficiencyInternet research skillsMedical terminology certificationMicrosoft Office certification