Provider Reimburse Admin Sr (US)
About The Position
Provider Reimbursement Admin Sr Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Provider Reimbursement Admin Sr is responsible for ensuring accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. Serves as subject matter expert regarding reimbursement policies, edits, and coding conventions. How you will make an impact: Works with vendors and enterprise teams to develop enterprise reimbursement policies and edits, ensuring policies and edits do not conflict with Federal and state mandates. Works with other departments on claims adjudication workflow development and business process improvements. May lead the full range of provider reimbursement activities for a state(s). Leads projects related to provider reimbursement initiatives. Serves as a mentor to less experienced administrators.
Requirements
- Requires a BA/BS degree and a minimum of 4 years related experience; or any combination of education and experience, which would provide an equivalent background
Nice To Haves
- Payment methodology knowledge preferred
- WGS knowledge preferred
- Ability to multitask and complete deadlines preferred
Responsibilities
- ensuring accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria
- Serves as subject matter expert regarding reimbursement policies, edits, and coding conventions
- Works with vendors and enterprise teams to develop enterprise reimbursement policies and edits, ensuring policies and edits do not conflict with Federal and state mandates
- Works with other departments on claims adjudication workflow development and business process improvements
- May lead the full range of provider reimbursement activities for a state(s)
- Leads projects related to provider reimbursement initiatives
- Serves as a mentor to less experienced administrators
Benefits
- a comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
