Employer Industry: Healthcare Services

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Work remotely from various states, providing flexibility
- Competitive salary and performance-based incentives
- Supportive and collaborative work environment
- Chance to make a positive impact on managed care reimbursement processes

What to Expect (Job Responsibilities):
- Audit managed care claims payments and calculate reimbursements based on contract terms
- Identify issues with contract management projections and make recommendations to the Manager of Payer Relations
- Review technical denials and pursue additional payments under negotiated terms
- Independently identify payment trends and escalate issues related to managed care underpayments
- Effectively communicate with internal and external parties to resolve payment disputes

What is Required (Qualifications):
- Associate degree or comparable experience in a relevant role, such as a senior medical high dollar hospital reimbursement analyst
- Superior analytical skills and attention to detail
- Minimum three years of experience in managed care and variance follow-up in Epic
- Strong verbal and written communication skills
- Expert knowledge of Microsoft Office products, including Excel, Access, and Word

How to Stand Out (Preferred Qualifications):
- Bachelor's Degree in a related field with relevant experience
- Familiarity with managed care payment methodologies, including MS-DRG, APR-DRG, HCPCS, CPT, APC, and ICD-10

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