Top 28 Reimbursement specialist Jobs in Providence Ri

Senior Provider Reimbursement Analyst
Neighborhood Health Plan of Rhode Island —Smithfield, RI
- Full-time
- 5 years
- Finance
- Driver's License
- Health insurance
Quick Apply
Manager, Practice Integration (Northeast)
BioTissue Holdings Inc —Providence, RI
- $125,000 - $130,000 a year
- Full-time
- Surgery
- Up to 50% travel
- 5 years
- Paid parental leave
- Health savings account
Quick Apply
9d
Director of Reimbursement
Brown University Health —Providence, RI
- $140,774.40 - $232,273.60 a year
- 8 hour shift
- 5 years
- Office
- Finance
Field Reimbursement Director
Glaukos —Providence, RI
- $173,400 - $216,800 a year
- Full-time
- Remote
- Background check
- Up to 50% travel
- Marketing
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Director of Reimbursement and Budgeting
Signature Healthcare —West Bridgewater, MA
- $180,000 - $190,000 a year
- Full-time
- CPA
- Office
- Master's degree
- On-the-job training
Quick Apply
7d
Field Reimbursement Manager - Kidney (NJ-MD-DE)
Vertex Pharmaceuticals —United States
- $136,000 - $204,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- 5 years
- Loan repayment program
- Dental insurance
Field Reimbursement Manager - Kidney (Central Southwest - AZ, NM, TX, OK)
Vertex Pharmaceuticals —United States
- $136,000 - $204,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- 5 years
- Loan repayment program
- Dental insurance
Field Reimbursement Manager - Kidney (Great Plains - NV, UT, CO, NE, KS)
Vertex Pharmaceuticals —United States
- $136,000 - $204,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- 5 years
- Loan repayment program
- Dental insurance

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Utilization Review Specialist
Charles River Recovery —Weston, MA
Post high school training in the medical field, the insurance field or in the behavioral health field preferred. Provides corrective criticism and peer review.
$24 - $26 an hour
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Medical Billing Specialist - Liability Claims
The CCS Companies —Norwood, MA
Bachelor’s degree in business or related field. Demonstrated knowledge of state laws and insurance statutes. Strong technical knowledge in one or more areas of…
$24 - $28 an hour
Quick Apply
4d

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Documentation and Reimbursement Specialist
Nationwide Children's Hospital —Columbus, OH
Five years of experience in related field (physician billing experience), preferred. As required by listed licensure and/or certification requirement.
Reimbursement Variance Analyst
Orthopedic One —Westerville, OH
Revises Standard Fees to comply with federal & state billing regulations & guidelines. Candidates must have current certification as a Certified Professional…

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Senior Provider Reimbursement Analyst

Neighborhood Health Plan of Rhode Island -
Smithfield, RI

Quick Apply

Job Details

Full-time

Benefits

Health insurance

Qualifications

Financial model construction
Medicare
Managed care organization experience
Spreadsheets
Health insurance policy knowledge
CMS
CMS regulatory compliance
Driver's License
Insurance regulation
Medicare regulations
Contracts
Financial projection model development
Centers for Medicare & Medicaid Services (CMS) billing regulations
Healthcare financial management
Medicaid regulations
Medicaid
Productivity software
Data analytics technologies

Full Job Description

The Senior Provider Reimbursement Analyst is responsible for development and management of fee schedules, including sample schedules, and alternative payment methodologies (APM) that support strategic and corporate goals. This position develops provider reimbursement mechanisms using industry standards and in alignment with state and corporate financial initiatives and recommends areas for optimization. Oversees the end-to-end rate development processes for new, revised and deleted Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding System (HCPCS) codes; the implementation of systemic fee schedules and rate tables and ensures that fee schedules are configured in accordance with best practice. This position develops and maintains department fee schedule dashboards, reports and/or, presentations and conducts research to ensure financial information has been configured accurately; identifies trends and developments in competitive environments and presents findings to management.

Duties and Responsibilities:

Responsibilities include, but not limited to:

Responsible for provider reimbursement rate development for professional, institutional, ancillary and LTSS providers, ongoing analysis of current reimbursement models, schedules, and proposed changes
Responsible for the creation and maintenance of fee schedules, including but not limited to, sample fee schedules and standardized metrics for the quantification of quality, value and cost
Responsible to research and articulate current and emergent provider payment models and changes with the health care industry
Responsible for the creation of provider financial modeling to support alternative payment methodologies and reimbursement proposals in alignment with strategic and corporate goals
Development of payment hierarchy, gathering of business requirements and auditing of claim processing system(s) to ensure system configuration supports accurate fee schedule and default implementation; process changes as necessary
Completes complex and ad-hoc analyses and reporting
Represents the department at cross-functional meetings
Responsible for provider fee schedule auditing
Coordinates activities with auditors and actuaries, as applicable
Attends provider negotiations, as requested by management
Performs other duties as assigned
Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.

Salary Grade: H

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

Qualifications-

Required:

Bachelor’s degree in Mathematics, Finance, Economics or a related field or an equivalent amount of education and experience in lieu of a degree
Five (5) years’ experience with a managed care organization or a health care related organization (e.g. HMO, Medicaid, Medicare), specifically with commercial, Medicaid or Medicare contracting and reimbursement methodologies
Three (3) to five (5) years’ experience in provider reimbursement and Alternative Payment Methodology financial modeling (e.g. ACO, bundles, episodic payment, etc.)
Advanced skills in Microsoft Office suite, specifically in Excel
Demonstrated understanding and experience in data analytics, provider reimbursement mechanisms, such as Medicare reimbursement methodologies, fee-for-service, per diem, case rate, Diagnosis-Related Groups (DRG), Ambulatory Payment Classification (APC), Ambulatory Surgery Center (ASC), and Resource Utilization Group (RUGs)
Demonstrated understanding of contractual language, health insurance; insurance laws and regulations, including Medicare and Medicaid policies; claims processing; medical and insurance terminology
Knowledge of CMS, Federal and State laws and requirements and other applicable industry standards and benchmarks
Ability to travel including having reliable transportation. Must have a valid driver’s license and proof of insurance if using own vehicle

Preferred:

Master’s degree in Health Care Informatics, Health Care Administration, Business Administration or Public Health or a related field
American Academy of Professional Coders (AAPC) certification

Salary Grade: H

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reimbursement specialist jobs in providence ri

Senior Provider Reimbursement Analyst

Manager, Practice Integration (Northeast)

Director of Reimbursement

Field Reimbursement Director

Director of Reimbursement and Budgeting

Field Reimbursement Manager - Kidney (NJ-MD-DE)

Field Reimbursement Manager - Kidney (Central Southwest - AZ, NM, TX, OK)

Field Reimbursement Manager - Kidney (Great Plains - NV, UT, CO, NE, KS)

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