Position Summary
Responsible for supporting managed care operations through contract analysis, reimbursement validation, payer relations, healthcare analytics, contract administration, and operational support. Performs reimbursement analysis, payment variance investigations, contract modeling support, payer policy research, denial analysis, reporting, and assists with payer negotiations and implementation activities.
Collaborates with Revenue Cycle, Finance, Decision Support, Provider Enrollment, HIM, Clinical Operations, and physician leadership to improve reimbursement accuracy, contract compliance, operational efficiency, and value-based reimbursement performance.
Work Environment
This is a fully on-site position based in Hickory, North Carolina.
Education
- Associate degree in Business, Finance, Healthcare Administration, Accounting, Health Information Management, or a related field; or equivalent combination of education and experience
- Preferred: Bachelor's degree
Experience
- 2–5 years of experience in managed care, reimbursement analytics, revenue cycle, healthcare finance, decision support, or payer operations
- Knowledge of Medicare, Medicare Advantage, Medicaid, and Commercial reimbursement methodologies, including CMS fee schedules, APC, DRG, physician fee schedule, and prospective payment systems
- Working knowledge of ICD-10-CM/PCS, CPT, HCPCS, MS-DRGs, and APCs
- Working knowledge of hospital and professional billing, claim processing, reimbursement methodologies, and payer payment systems
- Experience reviewing contract language, analyzing reimbursement variances, identifying underpayments and overpayments, monitoring payer trends, researching denials, and supporting appeal preparation
- Preferred: Familiarity with payer grievance processes, CMS complaint processes, Department of Insurance (DOI) complaints, and regulatory payer issue resolution
Core Competencies
- Analytical thinking
- Financial analysis
- Problem solving
- Communication
- Collaboration
- Attention to detail
- Organization and time management
- Accountability
- Adaptability
- Confidentiality
- Continuous improvement
Location
North Carolina, US
Employment Type
Temporary
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 month ago