Hybrid Program Reimbursement Specialist II

FALL CREEK FARM & NURSERY; Austin (TX); On-site; USD 42,000 - 66,000; Full time

Benefits offered by this job

Telework three days a week

Job summary

Health & Human Services Commission in Austin seeks a Program Specialist II to provide complex technical assistance to facility reimbursement staff. The role oversees Medicaid, Medicare, and other third-party payor claims, ensuring efficient processing and revenue recovery.

The position requires knowledge of third-party payors, EHR systems such as Avatar, and the ability to analyze and implement reimbursement programs.

Qualifications

• High school diploma/GED (Required)
• Experience with third-party payors, Medicaid, and Medicare claims processing (Preferred)
• Experience with third-party credentialing processes and contracts (Required)
• Experience liaising with third-party payors to maintain contracts/credentialing (Preferred)
• Experience with internal desk audits of claim payments and denials (Preferred)
• Experience with the Texas Administrative Codes rules and regulations (Preferred)

Responsibilities

• Provides complex technical assistance and consultative services to facility reimbursement staff. Oversees Medicaid, Medicare, third-party insurances, and other claims activity.
• Assists in planning, analyzing, developing, implementing, monitoring, and problem solving for reimbursement programs.
• Completes third-party credentialing applications, assists with desk audits, and resolves issues with reimbursement staff.

Skills

Medicare Knowledge

Medicaid Knowledge

Private health insurance knowledge

Accounting procedures

Accounts receivable

Reporting

Communication skills

EHR systems (Avatar)

Outlook

Word

Excel

Education

High school diploma/GED

Tools

Outlook

Word

Excel

Job description

Health & Human Services Commission in Austin seeks a Program Specialist II to provide complex technical assistance to facility reimbursement staff. The role oversees Medicaid, Medicare, and other third-party payor claims, ensuring efficient processing and revenue recovery.

The position requires knowledge of third-party payors, EHR systems such as Avatar, and the ability to analyze and implement reimbursement programs.