Job description

REIMBURSEMENT ANALYST, NETWORK MANAGEMENT

Position Summary:

The major responsibility of the Reimbursement Analyst, Network Management is to provide administrative and analytical support to Network Reimbursement and Network Contracting.

Position Responsibilities:

Respond to fee allowable requests from providers and/or Network contracting team.
Format fee proposals and fee playbacks
Install/implement fee schedules and rate structures in pricing system.
Manage inventory (i.e. fee installations, allowable requests, customer service inquiries and claim inquiries) to meet required turn-around times and team-based performance measures.
Complete front-end analysis of professional provider fee evaluations.
Respond to customer service and claim inquiries related to pricing issues within required turn-around times.
Consult with professional providers, Network Contractors, and other departments on pricing related issues.
Assist with testing of pricing system updates when needed
Analyze and research professional drug reimbursement to assist in setting competitive pricing as requested by provider and/or Network Contractor.
Run applicable claim detail reports when needed to determine pricing discrepancies or evaluation for possible claims cleanup/
Conduct ongoing quality reviews as it relates to reimbursement tasks and provide recommendations regarding operational improvements and/or streamlining of departmental processes and reports as needed.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Position Qualifications:

Required

High School Diploma

Preferred

2+ years' experience in healthcare and/or managed care industry with a focus on analytics
Knowledge of CPT/HCPCS coding and general claims processing guidelines

Skills, Knowledge, And Abilities

Strong analytical and organizational skills
Ability to learn and adapt to new software and analytic frameworks
Excellent communication skills, both verbal and written
Strong computer skills. Proficiency in Excel, Access, and MS Word
Ability to work independently, prioritize, and follow through with assignments in a high-paced environment

Key Competencies & Values

Collaboration
Integrity
Ethical practices and confidentiality

MedCost provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

MedCost participates in the Electronic Verification system (E-Verify) to electronically verify the work authorization of newly-hired employees. E-Verify is an internet-based program that compares information from an employee's Form I-9 to data contained in the federal records of the Social Security Administration and the Department of Homeland Security to confirm employment eligibility. MedCost does not use E-Verify to pre-screen job applicants.

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