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Provider Reimbursement Admin
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Full-time
- Location: This position will work a hybrid model (remote and office) and has an on-site requirement of 1-2 days/week.
- The Provider Reimbursement Admin ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.
- Reviews company-specific, CMS-specific, and competitor-specific medical policies, reimbursement policies, and editing rules, as well as conducts clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
- Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
- Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.
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