Provider Reimbursement II
Medica•St. Louis, MO
•$56,600 - $84,840•Hybrid
About The Position
This role is responsible for the development, configuration, maintenance, and validation of provider fee schedules used in claims adjudication. This role partners closely with internal operations, IT, and provider contracting teams to ensure accurate rate implementation and alignment with contract terms. The role ensures that reimbursement methodologies are correctly translated into system logic and that pricing data supports timely and accurate claims processing.
Requirements
- Bachelor's degree or equivalent experience in related field
- 3+ years of work experience beyond degree
- Legally authorized to work in the United States at the time of application.
Responsibilities
- Build, configure, and maintain healthcare fee schedules
- Interpret provider contracts and reimbursement terms to translate into system-ready pricing logic.
- Apply regulatory updates (e.g., Medicare fee schedule updates, coding changes) to ensure compliance and accuracy.
- Conduct periodic reviews and audits of fee schedules to ensure alignment with contractual and regulatory requirements.
- Serve as a subject matter expert (SME) for fee schedule design and claims pricing processes.
- Identify opportunities to improve pricing processes, automation, and controls.
- Support implementation of new reimbursement models and system upgrades.
Benefits
- competitive medical, dental, vision
- PTO
- Holidays
- paid volunteer time off
- 401K contributions
- caregiver services
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
