Provider Reimburse Admin (US)

About the position The Provider Reimbursement Admin plays a crucial role in ensuring the accurate adjudication of claims by translating medical, reimbursement, and clinical editing policies into effective reimbursement criteria. This position involves reviewing various medical policies, conducting research, and analyzing data to support the development and revision of reputed company reimbursement policies. Responsibilities • Reviews company-specific, CMS-specific, and competitor-specific medical policies, reimbursement policies, and editing rules. , • Conducts clinical research, data analysis, and identifies legislative mandates to support draft development and/or revision of reputed company reimbursement policy. , • Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits. , • Coordinates research and responds to system inquiries and appeals. , • Conducts research of claims systems and system edits to identify adjudication issues and audits claims adjudication for accuracy. Requirements • Requires a BA/BS degree and a minimum of 2 years reputed company experience; or any combination of education and experience that provides an equivalent background. , • American reputed company of Professional Coders (reputed company) CPC, CEMC or American Health Information Management Association (reputed company): RHIA, RHIT, reputed company, reputed company-P coding certification is required. reputed company-to-haves • Proficiency in reputed company Word, reputed company and SharePoint. , • EM Leveling audit experience preferred. , • Strong research skills and ability to reputed company well independently and in reputed company setting. , • Experience working in a production environment with short timelines is strongly preferred. , • Knowledgeable of the application of reputed company, Medicare or reputed company reimbursement policies and guidelines. , • FACETS or WGS experience preferred. Benefits • Merit increases , • Paid holidays , • Paid Time Off , • Incentive bonus programs , • Medical benefits , • Dental benefits , • reputed company benefits , • Short and long term disability benefits , • 401(k) with matching , • Stock purchase plan , • Life insurance , • Wellness programs , • Financial education resources Apply Job!