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Reimbursement Specialist, Contracts Analyst 3 (NY) in New York, NY at APEX Systems

Date Posted: 4/16/2019

Job Snapshot

Job Description

Job #:  960882

Summary: Serve as the subject matter expert to on issues related to provider reimbursementJob Responsibilities: Evaluate the effectiveness of contracting strategies, payment methodologies and rates in comparison to budget of quality initiatives Establish financial benchmarks for provider reimbursement and analyze the impact of contracts submitted by the Health Plans Manage and modify the process for changes to outcomes analysis reports due to various needs and concerns Prepare and present information on emerging and industry standard reimbursement methods, competitive information, and national initiatives to management in support of network strategy discussions Oversee various projects including the design of physician incentives and other contractual arrangements Maintains divisional provider reimbursement models providing analytic reporting capabilities for contracting staff, contract settlement, incentive pool distribution, and estimation of savings through a variety of proposed contract/reimbursement actions Perform analyses of Health Plan reimbursements in comparison to Centene’s national experiences Develop, export and train Health Plan financial analysts on the use financial modeling tools for provider reimbursement and medical expense forecasting Assist with formulating and administering organization policies and proceduresEducation/Experience: Bachelor’s degree in related field or equivalent experience. Working knowledge of contract management processes, claims processing procedures, reimbursement and payment methodologies, and claims systems requirements and controls. Experience with statistics and the application of higher level mathematical models to medical and pharmacy claims data.5-7 years of experience Comments for Vendors: Job title: Provider Reimbursement Specialist
**Please view attached job description**
**Immediate need**
Please make sure that the person understand managed care and fee schedules
Bill Rate$32/hr
Work schedule: 8:30-5pm 
Prior experience is Oracle, VBA, Python, Microsoft Powerpoint, Access, Word, and Excel is a plus.

 

 

 

 

 

 

 

 

EEO Employer

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