Managed Care and Reimbursement Specialist

FRC•Fairfax, VA

4d•Hybrid

About The Position

Fairfax Radiology Centers is seeking a detail-oriented, analytical, and collaborative Managed Care and Reimbursement Specialist for its Revenue Cycle team. This role supports payer relationships and contract administration, analyzes reimbursement trends, resolves complex insurance issues, and helps ensure payer contracts and reimbursement processes are implemented accurately across the organization. The position works with organizational leadership, insurance payers, external billing partners, and internal departments to strengthen reimbursement accuracy and revenue cycle performance. The role is hybrid, initially requiring on-site work one to two days per week, with potential for increased remote flexibility based on departmental needs. This is an internal posting for current FRC employees only.

Requirements

Associate degree or higher in Healthcare Administration, Health Sciences, Accounting, or a related field, plus at least one year of healthcare revenue cycle experience in medical billing, payer reimbursement, insurance denials, accounts receivable, or managed care operations; an equivalent combination of education and experience will be considered.
Working knowledge of healthcare insurance plans, payer requirements, reimbursement methodologies, and medical billing processes.
Familiarity with CPT/HCPCS and ICD-10 coding concepts.
Proficiency with Microsoft Excel, including PivotTables and VLOOKUP, and the ability to analyze, reconcile, and interpret reimbursement and financial data.
Experience researching and resolving complex insurance payer issues, reimbursement discrepancies, or contract-related matters.
Strong analytical, problem-solving, organizational, and communication skills, with the ability to collaborate effectively with internal and external partners.

Nice To Haves

Professional certification in healthcare billing, coding, reimbursement, or revenue cycle, such as CPC, CRCR, CBCS, CRCS, or a comparable certification.
Experience in managed care, payer contracting, or reimbursement analysis, including experience working with smaller insurance carriers and workers' compensation payers.

Responsibilities

Support payer contract administration, network participation, reimbursement analysis, and implementation of new insurance products and contract changes.
Research payer policies, insurance products, reimbursement methodologies, and regulatory changes to identify financial and operational impacts.
Monitor Medicare and applicable federal and state payer requirements, including Virginia-specific regulations.
Analyze reimbursement rates, fee schedules, and contract provisions to support payer negotiations and organizational decision-making.
Coordinate with insurance payers, external billing partners, and internal departments to resolve complex reimbursement and contract-related issues.
Maintain accurate fee schedules and communicate payer updates to support consistent implementation across systems and workflows.
Analyze payment trends and reimbursement patterns to identify underpayments, contract discrepancies, payer configuration issues, and potential revenue leakage.
Investigate complex payer and reimbursement issues, determine financial impact, and help develop corrective solutions.
Validate reimbursement accuracy following payer or system corrections.
Use Excel and other analytical tools to evaluate contract performance, reconcile reimbursement data, and support financial decision-making.
Serve as a resource to internal teams, including Hospitality, Pre-Authorization, and Operations, on payer participation, insurance coverage, and reimbursement questions.
Collaborate with external billing partners and affiliated organizations, including Inova Managed Care, to research and resolve payer-related concerns.
Support payer directory accuracy, network participation, insurance information, and provider or location discrepancy resolution.
Assist with special billing arrangements, reimbursement evaluations, self-pay pricing, and implementation of new services and rates.
Support accurate configuration of payer profiles, insurance products, fee schedules, and reimbursement information within revenue cycle systems.
Participate in system testing and implementation of payer, contract, and workflow changes.
Identify opportunities to streamline processes, improve reporting, and strengthen reimbursement accuracy.
Contribute to cross-functional initiatives and special projects supporting revenue cycle performance.