Senior Provider Reimbursement Specialist

A company is looking for a Provider Reimbursement Policy Specialist Sr.

Key Responsibilities

Create and maintain standardized documentation for medical and clinical claim payment policies

Research and advise on Medical Coding and translate health care benefits to procedure code level

Act as a liaison between Payment Integrity vendors and internal teams to implement and troubleshoot Medical Policy Reimbursement

Required Qualifications

Associate's Degree or equivalent experience in Medical Policy and Reimbursement Claim Edits

Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC) + Certified Professional Coder-Hospital (COC)

10 or more years in Claim Auditing, Claims Billing, or related positions within a medical facility or insurance carrier

10 or more years in a Business Analyst function with a medical insurance carrier operations team

Experience with Medicaid, Medicare, and Commercial Insurance