Analyst Reimbursement Managed Care - Remote

Talentify.io; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company in healthcare services is seeking a dedicated professional for a remote position in healthcare reimbursement. This role involves analyzing payment variances, ensuring accurate provider enrollment, and requires a strong grasp of reimbursement rules. Candidates with relevant experience will find ample opportunities for career growth and development in a supportive and engaging work environment.

Benefits

Comprehensive benefits from Day One

Mental health resources and support

Opportunity for career advancement

Qualifications

• 3 years of relevant experience in healthcare reimbursement required.
• In-depth knowledge of reimbursement rules for Commercial and Government payers.
• Excellent interpersonal skills and ability to work independently.

Responsibilities

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

Skills

Analytical reasoning

Critical thinking

Problem-solving skills

Education

High School diploma or equivalent

Bachelor's degree in healthcare or business administration

Tools

Payment variance software

Microsoft Office applications

Athena/Epic systems

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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