Talent.com
Lead Analyst, Reimbursement

Lead Analyst, Reimbursement

Veterans StaffingFort Worth, TX, US
job_description.job_card.variable_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
job_description.job_card.job_description

Lead Analyst, Reimbursement

The Lead Analyst, Reimbursement is responsible for administering complex provider reimbursement methodologies timely and accurately. Supports existing lines of business and expansion into new states. The Lead Analyst, Reimbursement will be primarily responsible for implementation, maintenance, and support of provider reimbursement for all provider types, including hospitals and facilities priced through PPS pricing methodologies. Works closely with IT, the pricing software vendor, operations, health plan representatives, and other business teams involved in claim processing. Maintains expertise in all forms of reimbursement methodologies including fee for service, value based pricing, capitation, and bundled payments (APG, EAPG, APR-DRG, MS-DRG, etc.). Works with internal and external stakeholders to understand business objectives and processes associated with the enterprise. Ensure deliverables are completed on time with high quality. Trains staff on reimbursement team activities and troubleshooting.

Job Duties :

  • Research, review, and decipher state-specific Medicaid and Medicare reimbursement methodologies for providers, including hospitals and facilities.
  • Developing expertise in complex groupers (APG, EAPG, APR-DRG, MS-DRG, etc.) utilized in reimbursement priced through PPS payment methodologies.
  • Support implementation of new pricers including : reviewing pricing software vendor specifications, identifying system changes needed to accommodate state-specific logic, assisting with requirements development, and creating and executing comprehensive test plans.
  • Ongoing pricer maintenance, quality assurance, and compliance with deployment activities.
  • Interpret release notes to accurately request and analyze impact reports of affected claims.
  • Analyzes, interprets, and maintains configurable tables and files that support claim adjudication rules, benefit plan support, and provider reimbursement rules.
  • Assists in the development and execution of testing scenarios and conditions.
  • Performs unit and / or end-user testing for new configuration, programming enhancements, new benefit designs, new provider contracts, and software changes.
  • Analyze and review concerns and pricing variances to validate results, determine root causes drivers, and develop solutions if necessary.
  • Work closely with IT and pricing software vendor to resolve issues.
  • Develop policies and procedures.
  • Identify automation and improvement opportunities.
  • Research and resolve reimbursement inquiries from internal teams and providers.
  • Trains staff on reimbursement team activities and troubleshooting.
  • Participates in various department-wide projects.
  • Works with internal and external stakeholders to understand business objectives and processes associated with the enterprise.
  • Problem solves with Health Plans and Corporate to ensure all end-to-end business requirements have been documented.
  • Creates management reporting tools to enhance communication on team updates and initiatives.
  • Negotiates expected completion dates with Health Plans.
  • Ensure deliverables are completed on time with high quality.
  • Other duties as assigned.

Job Qualifications :

Required Education : Associates Degree or equivalent combination of education and experience

Required Experience / Knowledge, Skills & Abilities :

  • 5 - 10 years' experience in Managed Care
  • 5 or more years hospital reimbursement methodologies
  • Background in provider contracts, pricing configuration, claim adjudication or reimbursement processes
  • Experience processing or reviewing facility claims
  • Prior professional experience utilizing Microsoft Excel (e.g., performing basic data analysis in excel and utilizing pivot tables and various functions such as VLOOKUP)
  • Strong analytical skills to manage complex reimbursement policies and trends.
  • Excellent communication skills to interact with various stakeholders and explain complex reimbursement issues.
  • Preferred Education : Bachelor's Degree or equivalent combination of education and experience

    Preferred Experience :

  • Experience researching and resolving provider reimbursement inquiries.
  • Intermediate to Advanced Microsoft Excel skills
  • To all current Molina employees : If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V. Pay Range : $77,969 - $155,508 / ANNUAL

  • Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
  • serp_jobs.job_alerts.create_a_job

    Reimbursement Analyst • Fort Worth, TX, US

    Job_description.internal_linking.related_jobs
    • serp_jobs.job_card.promoted
    Contracts - PBM - Senior Analyst

    Contracts - PBM - Senior Analyst

    CVS HealthIrving, TX, US
    serp_jobs.job_card.full_time
    At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading h...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Lead Platform Analyst

    Lead Platform Analyst

    Vizient, Inc.Irving, TX, United States
    serp_jobs.job_card.full_time
    When you're the best, we're the best.We instill an environment where employees feel engaged, satisfied and able to contribute their unique skills and talents. We provide extensive opportunities for ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Cyber Technology Risk, Change and Program Lead Analyst

    Cyber Technology Risk, Change and Program Lead Analyst

    CitiIrving, TX, United States
    serp_jobs.job_card.full_time
    The Technology and Cyber Compliance and Operational Risk Office (TCCORO) at Citi is the firm’s reliable second set of eyes. Our mission is to drive comprehensive and consistent practices designed to...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
    • serp_jobs.job_card.promoted
    Analyst, Disbursements

    Analyst, Disbursements

    Brinker InternationalCoppell, TX, US
    serp_jobs.job_card.full_time
    What does it mean to be a BrinkerHead? We play like a team, take pride in our culture and seek every opportunity to make people feel special. At Brinker, we connect, serve and give to create the bes...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Sr. Director, Analyst Relations (Remote-US)

    Sr. Director, Analyst Relations (Remote-US)

    GartnerIrving, TX, US
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    Analyst Relations Professional.Gartner's Business and Technology Insights Group advises technology companies on the strategic business issues that help make them successful in their market and thei...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Lead Analyst, Operations Research Analytics - Hybrid

    Lead Analyst, Operations Research Analytics - Hybrid

    XPONorth Richland Hills, TX, US
    serp_jobs.job_card.full_time
    What you’ll need to succeed as Lead Analyst, Operations Research Analytics at XPO Minimum qualifications : Educational Background PhD or MS in Operations Research, Industrial Engineering, Computer S...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Epic Resolute Professional Billing Application Analyst I, II, III-((Open to experienced remote in ID, TN, MO, OK, TX)

    Epic Resolute Professional Billing Application Analyst I, II, III-((Open to experienced remote in ID, TN, MO, OK, TX)

    PIH HealthIrving, TX, US
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    Determination for the Epic Application Analyst (I, II or III), Resolute Professional roles will be based on experience and qualifications. Not currently working with 3rd party recruitment agencies.F...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
    • serp_jobs.job_card.promoted
    Risk Management Analyst with IAM

    Risk Management Analyst with IAM

    KaavRoanoke, TX, US
    serp_jobs.job_card.full_time
    IAM Westlake, Texas (Hybrid role) Looking for individuals with strong risk management controls skills.serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Charge Master Analyst II - Revenue Integrity

    Charge Master Analyst II - Revenue Integrity

    Christus HealthIrving, Texas, US
    serp_jobs.job_card.full_time
    Description Summary : The Charge Master Analyst II will be responsible for ensuring accurate patient billing according to governmental policies and CHRISTUS compliance and integrity policies for t...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Epic Resolute PB Analyst II

    Epic Resolute PB Analyst II

    Texas Health ResourcesArlington, TX, United States
    serp_jobs.job_card.full_time
    Epic Resolute PB Analyst II - IT Ambulatory Business Applications.Bring your passion to Texas Health so we are Better + Together. Texas Health Resources, 612 East Lamar Blvd, Arlington, TX 76011.Pri...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Charge Master Analyst II-Revenue Integrity

    Charge Master Analyst II-Revenue Integrity

    Christus HealthIrving, Texas, US
    serp_jobs.job_card.full_time
    Description Summary : The Charge Master Analyst II will be responsible for ensuring accurate patient billing according to governmental policies and CHRISTUS compliance and integrity policies for t...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Senior Compensation Analyst

    Senior Compensation Analyst

    Matrix Service CompanyFort Worth, TX, United States
    serp_jobs.job_card.full_time
    The Senior Compensation Analyst designs, develops, and administers the Company's non-executive compensation programs.Full-time remote work is available for this role. Actively supports the Company's...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Applications Support Tech Lead Analyst

    Applications Support Tech Lead Analyst

    CitiIrving, TX, United States
    serp_jobs.job_card.full_time
    Applications Support Tech Lead Analyst for its Irving, Texas location.Duties : Lead the effort of developing, enhancing, and maintaining risk and regulatory application components.Enhance and mainta...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Cyber Technology Risk, Change and Program Lead Analyst

    Cyber Technology Risk, Change and Program Lead Analyst

    Citigroup IncIrving, TX, United States
    serp_jobs.job_card.full_time
    The Technology and Cyber Compliance and Operational Risk Office (TCCORO) at Citi is the firm’s reliable second set of eyes. Our mission is to drive comprehensive and consistent practices designed to...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
    • serp_jobs.job_card.promoted
    Senior IAM Analyst

    Senior IAM Analyst

    Vizient, Inc.Irving, TX, United States
    serp_jobs.job_card.full_time
    When you're the best, we're the best.We instill an environment where employees feel engaged, satisfied and able to contribute their unique skills and talents. We provide extensive opportunities for ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Pricing Business Systems Liaison (Pharma) (Remote)

    Pricing Business Systems Liaison (Pharma) (Remote)

    MCKESSONIrving, TX, United States
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare.We are known for delivering insights, products, and services that make quality care more accessibl...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Compensation Analyst

    Compensation Analyst

    Abacus Service CorporationFort Worth, TX, US
    serp_jobs.job_card.temporary
    There is a need for one Compensation Analyst.This would be a temp to perm role.This is not a virtual position.Work onsite location : Monday through Friday, 8am to 5pm at our office located at 3840 H...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Lead Risk Analyst

    Lead Risk Analyst

    LuminantIrving, TX, US
    serp_jobs.job_card.full_time
    Lead member of the Risk Group, focused on ETRM related activities.Requires a thorough understanding of risk control principles and systems. Develop tools that requires critical risk calculation and ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Sr. Analyst CIP Compliance

    Sr. Analyst CIP Compliance

    TXU EnergyIrving, TX, US
    serp_jobs.job_card.full_time
    Analyst CIP Compliance position will be responsible for providing leadership, independent compliance oversight, guidance, and direction needed to maintain on-going compliance with all applicable NE...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Risk Appetite Strategy and Tech Lead Analyst - VP (hybrid)

    Risk Appetite Strategy and Tech Lead Analyst - VP (hybrid)

    CitigroupIrving, TX, US
    serp_jobs.job_card.full_time
    Enterprise Risk Management Lead.Individuals in the Enterprise Risk Management are entrusted with managing the diverse and collective impact of the banks risks. This involves identifying and managing...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30