Offer summary

Qualifications:

Bachelor’s degree in business administration, sciences, nursing or a related field or equivalent work experience., A minimum of 3 years’ experience in reimbursement and coding, with knowledge of coverage policies and regulations., Strong understanding of federal, state, and industry reimbursement regulations and compliance., Advanced personal computer skills, including proficiency in Microsoft Office..

Key responsabilities:

Review and address lower- to mid-level pricing issues during the contracting process.

Triage reimbursement-related inquiries and escalate complex cases as necessary.

Ensure compliance with reimbursement regulations at federal, state, and industry levels.

Interpret complex disease states and communicate technical product information effectively.

Job description

Summary

Our client, a Fortune 500 medical device company, has engaged GForce Life Sciences to provide a detail-oriented and knowledgeable Clinical Reimbursement and Pricing Specialist to support the pricing and contracting process by triaging and resolving lower- to mid-level pricing deviations and related issues. The ideal candidate will have 2–4 years of experience in reimbursement and coding, with a strong understanding of healthcare compliance and technical reimbursement processes.

Job Duties

Review and address lower- to mid-level pricing issues that arise during the contracting process.
Triage reimbursement-related inquiries and escalate complex cases as needed.
Ensure compliance with federal, state, and industry reimbursement regulations.
Apply knowledge of US reimbursement coding, including DRG assignments and APC categorizations.
Interpret complex disease states and communicate related technical product information effectively.

Requirements

Bachelor’s degree in business administration, sciences, nursing or a related field or equivalent work experience
A minimum of 3 years’ experience involving coverage policies, procedures and regulations including but not limited to: Clinical and AdvaMed Code of Ethics on Interactions with Health Care Professionals.
Experience with US reimbursement coding, Diagnostic Related Group (DRG) assignments, Ambulatory Payment Classification (APC) categorization and process.
Demonstrated knowledge of federal, state and industry rules and regulations governing technical aspects of reimbursement and compliance
Ability to understand complex disease states and technical product information
Advanced personal computer skills, including experience with Microsoft Office
Experience with budget and contract negotiations.

Preferred Requirements