Provider Reimburse Admin Sr. Location: This position will work a hybrid model (remote and office). Ideal candidates must live within 50 miles of one of our PulsePoint locations. Schedule: This is a Hybrid 1 (home/office) position. The employee must work in the office 1-2 days per week. The Provider Reimburse Admin Sr ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. Serves as subject matter expert regarding reimbursement policies, edits, and coding conventions. Works with vendors and enterprise teams to develop enterprise reimbursement policies and edits, ensuring policies and edits do not conflict with Federal and state mandates. Works with other departments on claims adjudication workflow development and business process improvements. May lead the full range of provider reimbursement activities for a state(s). Leads projects related to provider reimbursement initiatives. Serves as a mentor to less experienced administrators. Minimum Requirements: Requires a BA/BS degree and a minimum of 4 years related experience; or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities and Experience: RN; Medical billing and coding certification strongly preferred. Outpatient coding experience preferred. CPC highly preferred. AAPC highly preferred.
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