Analyst Reimbursement Managed Care - Remote

Freddie Mac; Maitland (FL); Remote; USD 50,000 - 70,000; Full time

Job summary

A leading company in healthcare services is seeking a professional to join their team focused on reimbursement processes. The role involves ensuring accurate provider loading, evaluating fee adjustments, and resolving claim denials, all while working in a supportive remote environment. Candidates should possess a high school diploma and relevant healthcare reimbursement experience, with opportunities for growth and development from Day One.

Benefits

Comprehensive benefits from Day One

Mental health resources and support

Career advancement opportunities

Qualifications

• 3+ years of experience in healthcare reimbursement for Commercial and Government payers.
• Knowledge of reimbursement rules and regulations for Commercial and Government programs.
• Experience with Athena/Epic systems preferred.

Responsibilities

• Ensure timely and accurate loading of providers with Managed Care contracted payers.
• Evaluate professional fee contractual adjustments for accuracy according to payer contracts.
• Review and resolve claim denials related to credentialing and enrollment.

Skills

Analytical reasoning

Critical thinking

Problem-solving

Education

High School diploma or equivalent

Bachelor's degree in healthcare or business administration

Tools

Payment variance software

Microsoft Office

Job description

Employer Industry: Healthcare Services

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Work remotely Monday to Friday from 8:00 am to 5:00 pm
- Comprehensive benefits available from Day One, including mental health resources and support
- Engaging work environment focused on community and the well-being of individuals
- Chance to contribute to meaningful projects that have a positive impact on healthcare reimbursement

What to Expect (Job Responsibilities):
- Ensure timely and accurate loading of providers with Managed Care contracted payers
- Evaluate professional fee contractual adjustments for accuracy according to payer contracts and guidelines
- Review and resolve claim denials related to the credentialing and enrollment status of providers
- Identify and analyze payment variances for professional fee contracts and government payers
- Liaise with payers to request provider profile updates and negotiate discounts as needed

What is Required (Qualifications):
- High School diploma or equivalent required
- Minimum of 3 years of relevant experience in healthcare reimbursement with Commercial and Government payers required
- In-depth knowledge of reimbursement rules and regulations for Commercial and Government programs
- Proficient in payment variance software and Microsoft Office applications
- Strong analytical reasoning, critical thinking, and problem-solving skills

How to Stand Out (Preferred Qualifications):
- Bachelor's degree in healthcare, business administration, or a related field
- Experience with Athena/Epic systems for identifying payment variances
- Ability to research and interpret payer rules and regulations
- Excellent interpersonal skills and ability to work independently
- Well-organized and detail-oriented with strong time management skills

#HealthcareServices #RemoteWork #CareerGrowth #HealthcareReimbursement #TeamCollaboration

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