Reimbursement Analyst - REMOTE

Molina Healthcare; Phoenix (AZ); Remote; USD 77,000 - 129,000; Full time

Job summary

A healthcare provider company in Phoenix is seeking an Analyst, Reimbursement to oversee complex reimbursement methodologies. Responsibilities include analyzing claims, supporting provider pricing, and collaborating with IT and various teams. Ideal candidates will have experience in Managed Care and proficiency in Microsoft Excel. Competitive salary and benefits are offered.

Benefits

Competitive benefits and compensation package

Qualifications

• 1 – 2 years’ experience in Managed Care.
• Background in provider contracts, pricing configuration, claim adjudication.
• Experience processing or reviewing facility claims.

Responsibilities

• Administer complex provider reimbursement methodologies.
• Research state-specific Medicaid and Medicare reimbursement methodologies.
• Develop policies and procedures for reimbursement.

Skills

Data analysis

Excellent communication

Analytical skills

Familiarity with provider contracts

Education

Associates Degree or equivalent

Bachelor's Degree preferred

Tools

Microsoft Excel

Job description

Job Description

Job Summary

The Analyst, Reimbursement is responsible for administering complex provider reimbursement methodologies timely and accurately. The analyst will support existing lines of business and expansion into new states.

The Analyst, Reimbursement will be primarily responsible for implementation, maintenance, and support of provider reimbursement for all provider types, including hospitals and facilities priced through PPS pricing methodologies. Works closely with IT, the pricing software vendor, operations, health plan representatives, and other business teams involved in claim processing. Maintains expertise in all forms of reimbursement methodologies including fee for service, value based pricing, capitation, and bundled payments (APG, EAPG, APR-DRG, MS-DRG, etc.). This role is within the Configuration Solution Support team which falls under the Core Operations team for Technical Configuration and Configuration Information Management.

Job Duties

• Research, review, and decipher state-specific Medicaid and Medicare reimbursement methodologies for providers, including hospitals and facilities.

• Developing expertise in complex groupers (APG, EAPG, APR-DRG, MS-DRG, etc.) utilized in reimbursement priced through PPS payment methodologies.

• Support implementation of new pricers including:

• Reviewing pricing software vendor specifications.

• Identifying system changes needed to accommodate state-specific logic.

• Assisting with requirements development; and

• Creating and executing comprehensive test plans

• Ongoing pricer maintenance, quality assurance, and compliance with deployment activities.

• Interpret release notes to accurately request and analyze impact reports of affected claims.

• Analyzes, interprets, and maintains configurable tables and files that support claim adjudication rules, benefit plan support, and provider reimbursement rules.

• Assists in the development and execution of testing scenarios and conditions.

• Performs unit and/or end-user testing for new configuration, programming enhancements, new benefit designs, new provider contracts, and software changes.

• Analyze and review concerns and pricing variances to validate results, determine root causes drivers, and develop solutions if necessary.

• Work closely with IT and pricing software vendor to resolve issues.

• Develop policies and procedures

• Identify automation and improvement opportunities.

• Research and resolve reimbursement inquiries from internal teams and providers.

• Other duties as assigned.

Job Qualifications

REQUIRED EDUCATION

Associates Degree or equivalent combination of education and experience

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES

• 1 – 2 years’ experience in Managed Care

• Background in provider contracts, pricing configuration, claim adjudication or reimbursement processes

• Experience processing or reviewing facility claims

• Prior professional experience utilizing Microsoft Excel (e.g., performing basic data analysis in excel and utilizing pivot tables and various functions such as VLOOKUP)

• Strong analytical skills to manage complex reimbursement policies and trends.

• Excellent communication skills to interact with various stakeholders and explain complex reimbursement issues.

PREFERRED EDUCATION

Bachelor's Degree or equivalent combination of education and experience

PREFERRED EXPERIENCE

• 3 – 5 years’ experience in Managed Care

• Experience researching and resolving provider reimbursement inquiries.

• Intermediate to Advanced Microsoft Excel skills

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $77,969 - $128,519 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.