<p><b>Duties and Responsibilities: </b></p><ul><li>Understand claim payments and impact of fee-schedule updates from State/CMS.</li><li>Assist and monitor direct payment initiatives from the state for Provider Organizations</li><li>Responsible for contract analysis and fee schedule modeling.</li><li>Maintain current project logs and work plans on assignments.</li><li>Create and maintain database for fee schedules changes.</li><li>Collaborate and Coordinate with teams in Finance for all the planned projects for repricing/reprocessing.</li><li>Coordinate with Accounts Payable team to complete any payments outside of the core system (MHS)</li><li>Validate repricing/reprocessing projects outcome and follow up with Claims Operation teams for any fallout</li><li>Additional projects and duties as assigned.</li></ul><p></p><p><b>Minimum Qualifications: </b></p><ul><li>Bachelors degree from an accredited institution.</li><li>Work experience with SAS and/or SQL where you have created queries, pulled large data sets and performed data manipulations/analysis.</li><li>Experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing vLookups and advanced functions/ formulas; creating, using and interpreting pivot tables, filtering and formatting.</li><li>Knowledge of healthcare financial terms and claims processing.</li><li>Basic understanding of Medicaid and Medicare programs or other healthcare plans.</li><li>Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills. </li></ul><p><b>Preferred Qualifications: </b></p><ul><li>Bachelors degree in Finance, Math, Statistics or Computer Science from an accredited institution</li><li>1+ years of analytical work experience within the healthcare industry (i.e. hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)</li><li>Strong project management experience and ability to handle multiple projects in a fast-paced environment.</li><li>Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRGs), Ambulatory Patient Groups (APGs), Ambulatory Payment Classifications (APCs), and other payment mechanisms.</li><li>Understanding of value-based risk arrangements.</li><li>Experience using Tableau.</li></ul>
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