Reimbursement Coordinator, Intermediate

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Act as a consultant and educator for staff and administration regarding reimbursement, strategic savings initiatives, and coding compliance.

• Evaluate current and prospective reimbursement practices.

• Suggest suitable reimbursement based on contracts, policies, and industry standards.

• Provide consultative assistance concerning reimbursement methodologies and policies.

• Engage in discussions about current and future reimbursement initiatives.

• Contribute to ongoing educational presentations and serve as a senior member of the training team.

• Examine reimbursement opportunities through statistical reports, reimbursement summaries, and analytical methods.

• Assess coding practices and fee levels to evaluate their impact.

• Formulate reimbursement strategies.

• Prepare and deliver reports, recommendations, and guidance to leadership.

• Generate ad hoc reports estimating the reimbursement effects of policy and reimbursement-level modifications.

• Aid in the development, review, and revision of reimbursement schedules.

• Create code sets and payment methodologies that support strategic growth initiatives.

• Lead and delegate the review of new codes for appropriate fee-schedule inclusions and regulatory compliance.

• Act as the departmental liaison for investigating and resolving coding, reimbursement, and health-plan policy issues across provider contracting.

• Assist with data development and planning requirements.

• Draw insights from operational research and data analysis.

• Compile research into actionable insights.

• Provide pricing recommendations to various departments.

• Review selected provider claims to pinpoint reimbursement opportunities and support the recovery of incorrectly billed services.

• Analyze billed statistics, coding and charging practices, and industry data.

• Stay updated on current reimbursement methodologies and offer technical resources.

• Develop and maintain comprehensive resource web pages for staff and departments.

• Update the master fee schedule with current and historical reimbursement rates for contracted providers and hospitals.

• Operate in an office environment while adhering to job-specific responsibilities and organizational policies.

⛳️ Requirements

• High School Diploma or Equivalent (GED) (Required).

• At least 8 years of relevant experience (Required), which may include a combination of relevant experience and a degree.

• Resident of the Eastern Standard Time Zone.

• Strong communication skills.

• Ability to multitask effectively.

• Team collaboration skills.

• Capability to work independently.

• Proficiency and expertise in data applications and reporting tools.

• Ability to adhere to contractual, state, and federal regulations.

• Capability to work 40 scheduled hours weekly.

• Regular worker status.

• Exempt status.

🏝️ Benefits

• Healthcare benefits for both full-time and part-time positions starting from day one.

• Vision coverage.

• Dental coverage.

• Domestic partner benefits.

• Collaborative, cooperative, and collegial work environment.