Description and Requirements
The Sr. Analyst -Provider Reimbursement is responsible for projects related to claims repricing and reprocessing including but not limited to Distressed Hospitals Payments (DPT), Ambulatory Payment Groups (APG ). The incumbent of this position will translate State/CMS Fee Schedules into a manageable database. Additionally, the Sr. Analyst -Provider Reimbursement will contribute to a broad set of projects across the department. This position requires an individual with emerging skills in the areas of Network and healthcare and be someone who enjoys working in a fast paced and challenging environment.
Duties and Responsibilities:
- Understand claim payments and impact of fee-schedule updates from State/CMS.
- Assist and monitor direct payment initiatives from the state for Provider Organizations
- Responsible for contract analysis and fee schedule modeling.
- Maintain current project logs and work plans on assignments.
- Create and maintain database for fee schedules changes.
- Collaborate and Coordinate with teams in Finance for all the planned projects for repricing/reprocessing.
- Coordinate with Accounts Payable team to complete any payments outside of the core system (MHS)
- Validate repricing/reprocessing projects outcome and follow up with Claims Operation teams for any fallout...
- Additional projects and duties as assigned.
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Minimum Qualifications:
- Bachelor's degree from an accredited institution.
- Work experience with SAS and/or SQL where you have created queries, pulled large data sets and performed data manipulations/analysis.
- Experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing vLookups and advanced functions/ formulas; creating, using and interpreting pivot tables, filtering and formatting.
- Knowledge of healthcare financial terms and claims processing.
- Basic understanding of Medicaid and Medicare programs or other healthcare plans.
- Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills.
Preferred Qualifications:
- Bachelor's degree in Finance, Math, Statistics or Computer Science from an accredited institution
- 1+ years of analytical work experience within the healthcare industry (i.e. hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)
- Strong project management experience and ability to handle multiple projects in a fast-paced environment.
- Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms.
- Understanding of value-based risk arrangements.
- Experience using Tableau.
Hiring Range:
- Greater New York City Area (NY, NJ, CT residents): $81,100 - $117,470
- All Other Locations (within approved locations): $71,600 - $106,505
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.