Senior Reimbursement Strategist

Molina Healthcare, Inc.; United States; Remote; USD 54,000 - 118,000; Full time

Job summary

Molina Healthcare, Inc. is seeking a senior reimbursement analyst to provide expert support for provider reimbursement. You will work on complex PPS pricing, adjustments, and testing while maintaining price accuracy and coordinating with IT and pricing vendors.

The role requires 3+ years in provider reimbursement, strong analytical skills, and proficiency with Excel and claims systems. Collaboration with cross-functional teams and timely delivery are essential.

Qualifications

• 3+ years of experience in complex provider reimbursement, contracts, pricing configuration, or equivalent
• Advanced experience using a claims processing system
• Advanced experience processing facility claims and reimbursement inquiries
• Strong analytical and critical-thinking skills with ability to manage complex policies
• Ability to collaborate with stakeholders and explain complex reimbursement issues
• Flexibility to meet changing business requirements and deliver high quality on time
• High attention to detail and effective verbal and written communication
• Proficiency with Microsoft Excel (VLOOKUP, Pivot Tables) and related software

Responsibilities

• Research and decipher state Medicaid/Medicare/Marketplace reimbursement methodologies across providers
• Leverage expertise in complex groupers (APG, EAPG, APR-DRG, MS-DRG) used in PPS pricing
• Assist in implementing new prices including vendor specification review and test plans
• Maintain price accuracy and ensure deployment quality
• Analyze impact reports and reimbursement rules
• Collaborate with IT and pricing vendors to resolve issues
• Identify automation and improvement opportunities
• Provide reimbursement support for all health plan lines of business
• Train and support reimbursement team members
• Prioritize work to meet deadlines and department needs

Skills

Analytical thinking

Communication skills

Stakeholder collaboration

Detail oriented

Excel skills

Education

Bachelor's degree in healthcare/related field

Tools

Pricing software

Claims processing system

Job description

Molina Healthcare, Inc. is seeking a senior reimbursement analyst to provide expert support for provider reimbursement. You will work on complex PPS pricing, adjustments, and testing while maintaining price accuracy and coordinating with IT and pricing vendors.

The role requires 3+ years in provider reimbursement, strong analytical skills, and proficiency with Excel and claims systems. Collaboration with cross-functional teams and timely delivery are essential.