Healthcare Payment and Reimbursement Specialist

Join our dynamic team as a Healthcare Payment and Reimbursement Specialist! This is a fantastic opportunity to improve the healthcare landscape from the comfort of your home.

About You

As an essential member of our team, you will bring your expertise in healthcare payment and reimbursement methodologies, laws, and regulations, working under the supportive mentorship of our Project Manager. We look forward to learning about your experience in:

• Payer payment and reimbursement analysis
• Collaborating effectively within a team
• Upholding professionalism and integrity in your work
• Managing multiple projects while solving problems effectively
• What sets you apart as a candidate?

If you are passionate, team-oriented, and exemplify trust and honesty, we can’t wait to meet you!

About the Position

• Manage payment, pricing, and contract logic within healthcare reimbursement systems to ensure accurate claims adjudication.
• Analyze vendor bulletins, regulatory updates, and system changes to understand their impact on our processes.
• Review extensive healthcare data sets to identify trends and opportunities for improvement.
• Interpret policies related to Medicare, VA, CHAMPVA, and TRICARE, including various rulings and manuals.
• Collaborate with government agencies to clarify reimbursement and payment policies.
• Translate reimbursement policy updates into actionable business requirements for system configuration.
• Utilize advanced Excel modeling to validate and support payment methodologies.
• Identify essential claim data characteristics for testing pricing logic.
• Work closely with Development, QA, Data, and Client Services teams to ensure accurate implementation of requirements.
• Create and execute test claims for validation and troubleshooting.
• Maintain a deep understanding of the company’s products and healthcare services.
• Proactively address complex pricing and reimbursement issues while balancing multiple priorities.

Core Competencies

• Exceptional analytical and critical-thinking skills
• Meticulous attention to detail and quality
• Adept at turning complex policy and data into actionable solutions
• Strong collaboration and communication skills
• Self-motivated with excellent prioritization skills

Minimum Requirements

• 3-4 years of professional experience in healthcare provider payment and reimbursement.
• Strong knowledge of healthcare billing and payer reimbursement regulations.
• Experience with professional and institutional payment fee schedules, including systems like DRG, OPPS, Skilled Nursing, and Hospice.
• Ability to document intricate information into clear business requirements.
• Strong interpersonal and collaboration skills.
• Understanding of provider types and their reimbursement methodologies.
• Effective communication skills for diverse stakeholders.
• Preferred: SQL reporting experience.

Preferred Qualifications

• Proficiency in Microsoft Office applications.
• Experience with web-based research tools and regulatory resources.
• Knowledge of claims adjudication workflows.
• Experience with TriZetto Facets NetworX and Optum Rate Manager configuration.

About Us

At Signature Performance, we value exceptional talent that shares our mission of reducing healthcare administrative costs for federal agencies and providers. We believe in fostering a culture of passion, integrity, courage, and respect. Join us as we continue to grow and enhance our vision with dedicated individuals ready to impact our mission positively.

About the Benefits

As part of our team, you will enjoy a supportive work environment with a strong emphasis on work-life balance and continuous development opportunities. We offer competitive compensation and a comprehensive benefits package, including:

• Health Insurance
• Life Insurance
• Short & Long-Term Disability
• Paid Vacation & Sick Leave
• Paid Holidays
• Professional Development Assistance
• 401(k) Program with Employer Match

Security Requirements

• U.S. Citizenship or naturalized citizenship is required for this position.

Work Schedule: Monday - Friday, 8:00 AM - 5:00 PM CST

Compensation Range: $93,000 - $99,000 Annually

Position Type: Full Time