Healthcare Services Specialist

A company is looking for a Healthcare Services Segment Specialist (RAC).

Key Responsibilities

Lead reviews and updates of existing concepts based on client or regulatory changes

Conduct research and document impacts for new concept development while ensuring training material updates

Monitor and provide statistical analysis for audit concepts, ensuring compliance and timely application of regulatory changes

Required Qualifications

Minimum 8+ years of experience in healthcare claim type subject matter specialty

Bachelor's degree in a related field or equivalent experience

Registered Nurse or Certified Coder with nationally recognized credentials required

Broad knowledge of medical claims billing / payment systems and payer reimbursement policies

Progressive healthcare data analysis experience, including gathering and documenting requirements