Payer Payment & Reimbursement Analyst #HIRING

Position Description

ABOUT YOU

You are a person who loves to work with team members in healthcare payment & reimbursement methodologies, laws and regulations. We need someone who will review and analyze related vendor bulletins and updates for applicability and/or changes to internal process, product or data systems. In the role of Payer Payment and Reimbursement Policy Analyst, you'll be responsible for performing system configuration tasks related to contracts, pricing and reimburse for healthcare claims. If you can put your signature on this, we can't wait to hear from you!

• Tell us about your experience with Payer Payment and Reimbursement Analysis.
• Are you a team player and a self-motivator?
• What is your experience with conducting business in a way that is a credit to a company?
• We are counting on you to manage multiple projects using your problem-solving skills.
• We're looking for someone UNCOMMON. What is uncommon about you?

Are you highly committed? Are you team-oriented? Do you value professionalism, trust, honesty, and integrity? If so, we can't wait to meet you.

ABOUT THE POSITION

The people you will work with are exceptional. Here is what you can look forward to, and why you'll LOVE YOUR MONDAYS.

• Perform system configuration tasks related to contracts, pricing and reimburse for healthcare claims.
• Review and analyze related vendor bulletins and updates for applicability and/or changes to internal process, product or data systems.
• Review and analyze healthcare data sets for applicability and/or changes to changes to internal process, product or data systems.
• Read and analyze Medicare, VA, CHAMPVA, TRICARE data and policy including rulings, directorates, transmittals, bulletins, policy manual updates, physician fee schedule (data file).
• Contact various government entities to clarify new and existing policy.
• Interpret and deliver business requirements covering reimbursement updates and payment policy changes and enhancement features for translation into software design specifications.
• Create detailed excel formulas to explain and prove complex payment methodologies.
• Identify claim data characters for testing of pricing configurations.
• Coordinate with developers, QA, data, client service and other team members to ensure that business requirements are implemented accurately and timely.
• Develop test claims for Developers, UAT and QA.
• Perform configuration testing.
• Develop and maintain proficiency in the Company's products (software, data) and services, including commercial contracting features as related to the specific area(s) assigned.
• Experience working in the healthcare system with working knowledge of billing, compliance, and payer reimbursement guidelines/regulations.
• Ability to evaluate complex pricing issues for resolution
• Ability to work independently and prioritize workload according to project goals and objectives
• Core competencies include analytical thinking, information seeking, concern for quality, teamwork.

Position Requirements:

• Bachelor's degree in a healthcare, business, accounting, finance, or equivalent experience.
• 2-3 years professional experience in provider payment/reimbursements for healthcare, and familiarity with health care reimbursement systems and methodologies.
• Proficiency in Trizetto Facets NetworX Pricer Experience
• Experience working in the healthcare system with working knowledge of billing, compliance, and payer reimbursement guidelines/regulations.
• Experience in healthcare provider professional and institutional payment and reimbursement fee schedules (such as AWP, Physician Fee, DME/DEMPOS, Ambulance Lab, ESRD, Hospice, Dental, ASC, Anesthesia)
• Experience working with Prospective Payment Systems, including (Acute Inpatient, Hospital Outpatient, Skilled Nursing, Home Health, Long-Term Care, Inpatient Rehabilitation, Inpatient Psychiatric)
• Knowledge of Ambulatory Payment Classifications (APCs)
• Knowledge of Diagnosis Related Groups (DRGs)
• Knowledge of the integrated' Outpatient Code Editor (I/OCE) program
• Able to collect, research, and understand diverse information, and translate it into clear and concise written requirements.
• Able to plan, prioritize, and balance the need for direction with self-motivated efforts.
• Strong interpersonal skills
• Working knowledge of provider types and specialties, including the applicable fee schedule or reimbursement payment methodology for the provider type.
• Ability to effectively communicate and collaborate with diverse internal and external stakeholder groups and individuals.
• SQL report experience preferred

Preferred Qualifications:

• Proficiency in using MS Office (Teams, Word, Excel, PowerPoint, Visio, Access) software applications
• Proficiency in using various Web-based and other research sources and tools
• Knowledge of claims adjudication and payment
• RHIA, CPC, AMBA, CMRS, AAPC or CCB or similar certification

ABOUT US

You are uncommon. We are, too. We are looking for people to help us in our mission of working hard at lowering healthcare administrative costs for federal government agencies, payers, and providers. At Signature, our mission is to improve the health of our clients' business and make the lives of the people we work with better. As we continue to experience exponential growth, we are looking for uncommon individuals to enhance our vision. We will continue to accomplish our mission by leading with our values of Passion, Courage, Integrity, and Respect in all interactions, making us a consistent annual Best Places to Work organization. We need uncommon leaders with uncommon qualities to shape our uncommon culture and achieve our uncommon mission.

ABOUT THE BENEFITS

We're proud to put our signature on each one of our employees. When you are a member of Signature Performance, you are a part of a solutions-based organization where the values of passion, integrity, courage, and respect are the driving forces behind all our decision-making. We trust in you to do important work and bring the best version of yourself to work every day, so we want to help you achieve a work-life balance while consistently challenging yourself.

Signature believes in fully developing each one of our Associates. We deliver a performance-driven atmosphere with competitive pay, world-class training and development classes, resources, and events, an award-winning culture where everyone thrives, and so much more.

• Health Insurance for Our Associates
• Fully Paid Life Insurance
• Fully Paid Short- & Long-Term Disability
• Paid Vacation
• Paid Sick Leave
• Paid Holidays
• Professional Development and Tuition Assistance Program
• 401(k) Program with Employer Match
• Referral Bonuses
• Hybrid & Remote Opportunities

General Areas of Accountability:

Must conduct business and personal affairs in a manner that is always a credit to the company. Must maintain a good credit rating while employed with the company.

The following HIPAA and Privacy items apply to all positions at Signature Performance:

• Follow HIPAA guidelines for protecting the privacy and security of sensitive personal and/or health information.
• Follow Signature expected acceptable use to protect propriety and company owned information.
• Complete annually required Privacy and Security Training

Performance Management:

• All Signature Performance associates are subject to regular performance management to determine if skills and training requirements are suitable for the position.

Machines and Equipment:

The incumbent must be able to effectively operate the current computer system, telephone system, and other office machines such as copiers and fax machines.

Physical Activity:

• The incumbent must be able to finger, grasp, feel, see, sit, hear, and speak. This position is sedentary in nature with minimal lifting requirements.

Working Conditions:

The incumbent works in an office environment that is not substantially exposed to adverse environmental conditions such as heat, cold, or extreme noise. Routine periods of being on the phone utilizing a headset, sitting and data keying are required.

• Remote Eligibility: This position is Ad-hoc remote eligible. Eligibility is determined by Management or Talent Operations.

U.S. Citizenship is Required for All Positions and Work on All Positions Must Be Completed in the Continental United States, Alaska, or Hawaii.

The above statements are intended to describe the general nature of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

Compensation Range

$95,000.00 - $99,000.00/Annually

Position Type

Full-time

Regular or Temporary

Regular

Position Requirements

U.S. Citizenship is Required for All Positions

Work on All Positions Must Be Completed in the Continental United States, Alaska, or Hawaii

Work Schedule

Flexible Schedule During Normal Operating Hours