November 7, 2024

Inception Fertility Corporate Services

FULL TIME

Managed Care Contract Reimbursement Analyst

If you have at least 3 years of experience in healthcare billing, claims and payer reimbursement activities, this may be a great fit for you. This position will ensure that all Managed Care Payer Contract reimbursement terms are properly captured and maintained timely and appropriately within the identified required systems. This role will serve as a liaison between Executive Leadership, Managed Care, Accounting/Finance, and RCM members regarding payer contract rates as well as proper reimbursement calculations, determination, and tracking. Able to identify reimbursement rate trends and issues and communicate those accordingly to both the contracted payers and internal resources.
What this role entails:

Collects and maintains accurate data regarding contract rates from payors. Must be familiar with Availity, Navi Net, payer portals, CMS, and other health plan websites. Will also utilize internal platforms effectively as required.
Will ensure organization platforms accurately reflect reimbursement rates by payer source per the applicable contract terms and fee schedules to ensure proper net revenue calculations, contract performance and modeling and financial planning.
Documents and updates tracking tools and files in compliance with required version-controlled fee schedule format and system build requirements as well as any other impactful payment information, annually or as needed.
Assists in the monitoring of payer contract compliance based upon negotiated rates.
Able to effectively communicate any trends and discrepancies to the Payer Relations leadership as necessary for engagement with Payer sources accordingly.
Additional responsibilities as assigned.

What you offer:

Must be a tenacious go-getter, have the desire to learn to navigate barriers at health plans and the ability to work through and understand complex payment methodologies.
3-5 years’ experience in healthcare contracting, implementing/building fee schedule/reimbursement terms, billing system analytics, supporting and maintaining reimbursement terms within Patient Management Systems.
3-5 years’ experience revenue cycle, patient accounting and billing workflows and payer contract modeling within an applicable platform.

What we offer you!

Outstanding benefits including health, vision and dental packages, including HSA/FSA, Life and Disability Insurance
We also have a no-cost medical, dental, and vision plan for employees
18 days of accrued PTO in addition to 11 paid holidays
Fertility benefits
401(k) Retirement Plan
Employee Assistance Program
Continuing Education Reimbursement