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Sr Medicaid Reimbursement Regulatory Analyst
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- Research and decipher regulatory sources such as legislative rules, federal registers, and bulletins regarding payment rules for Medicare as well as deciphering contractual language regarding commercial payment arrangements
- Draft concise documentation for payment procedures-including payment calculation logic-and collaborate with the development team to refine into user stories with acceptance criteria, including creating test cases/claims with expected pricing outcomes
- Perform analysis of various data sources, including but not limited to, published fee schedules and provider files, using in-house or off-the-shelf software (such as Microsoft Excel)
- Lead pricer maintenance, quality assurance activities, audits, troubleshooting, and defect corrections
- 5+ years of experience in Medicaid billing, reimbursement, claim payment or cost reporting
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