Senior Provider Reimbursement Strategist

Nhpri; Smithfield (RI); On-site; USD 90,000 - 130,000; Full time

Job summary

Neighborhood Health Plan of Rhode Island is seeking a Finance/Reimbursement professional to develop and manage provider reimbursement rate schedules for professional, institutional, and other services. The role emphasizes analytics, model-building, and cross-functional collaboration to support strategic goals.

The candidate will research payment models, create financial projections, and ensure accurate fee schedules with dashboards and reports for leadership review.

Qualifications

• Bachelor's degree or equivalent education/experience in a related field.
• 5+ years in managed care or health care contracting and reimbursement.
• 3–5 years in provider reimbursement and financial modeling.
• Advanced Excel and MS Office skills.

Responsibilities

• Develop and manage provider reimbursement rate development for multiple provider types.
• Create and maintain fee schedules with standardized quality, value, and cost metrics.
• Research current and emerging provider payment models and present findings.
• Create provider financial models for alternative payment methodologies aligned with goals.
• Develop payment hierarchy and audit claim processing systems for accuracy.
• Complete complex analyses and ad-hoc reporting.
• Represent the department at cross-functional meetings.
• Coordinate with auditors and actuaries as needed.
• Attend provider negotiations as requested and ensure compliance with policies.

Skills

Data analytics

Provider reimbursement knowledge

Contract language understanding

CMS/Medicaid policy knowledge

Excel proficiency

Education

Bachelor's degree in Mathematics, Finance, Economics or related field

Master's degree in Health Care Informatics / Administration / Public Health (preferred)

Tools

Excel

Microsoft Office Suite

Job description

Neighborhood Health Plan of Rhode Island is seeking a Finance/Reimbursement professional to develop and manage provider reimbursement rate schedules for professional, institutional, and other services. The role emphasizes analytics, model-building, and cross-functional collaboration to support strategic goals.

The candidate will research payment models, create financial projections, and ensure accurate fee schedules with dashboards and reports for leadership review.