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Government Programs Specialist

3 months ago

Plano, Texas, United States FinThrive Full time

About FinThrive

FinThrive is advancing the healthcare economy.
For the most recent information on FinThrive's vision for healthcare revenue management visit

Award-winning Culture of Customer-centricity and Reliability

At FinThrive we're proud of our agile and committed culture, which makes FinThrive an exceptional place to work. Explore our latest workplace recognitions at

Our Perks and Benefits

FinThrive is committed to continually enhancing the colleague experience by actively seeking new perks and benefits. For the most up-to-date offerings visit

About the Role

Impact you will make

As a Government Programs Specialist with FinThrive, you are responsible for the management of federal and/or state pricing systems (Medicare, Medicaid, Tricare, ChampVA, Workers Compensation, and/or 3M pricing products) for hospital and professional reimbursement for FinThrive's Contract Manager and related solution. This role is paramount in ensuring data accuracy and reliability within FinThrive products as well as providing support to our revenue management solutions.

What you will do

  • Research and interpret federal and state regulations (Medicare, Medicaid, Tricare, ChampVA, Workers Compensation, and/or 3M pricing products) quarterly, annually, and as updates occur to determine what reimbursement has changed, inactivated, or added since previous updates were made to pricing
  • Check for regulatory updates on a weekly basis, at a minimum, for assigned documentation
  • Download and analyze reimbursement changes required
  • Analyze, load, and modify fee schedules, rates, and factors included individual hospital updates
  • Update minimum of 10 fee schedules monthly
  • Perform database design, development, and enhancement, as well as manage and coordinate changes to the existing pricing systems
  • Create test plans and execute quality assurance on newly developed or enhanced logic
  • Serve as backup to vendor deploy manager learning all components of that process
  • Successfully engage in multiple development initiatives simultaneously
  • Attend customer meetings as required as government pricing reimbursement subject matter expert
  • Review and analyze claims (protected health information - PHI) with customers to understand pricing issues identified
  • Update pricing logic and provide detailed specifications to the development team for pricing node changes
  • Respond to customer Salesforce cases in a timely manner based on documented policy
  • Research and close minimum of 30 Salesforce cases per month subject to volume received
  • Follow up verbally with customers as needed
  • Communicate with government agencies
  • Provide internal and external customer support from implementation to full adoption of Contract Manager or any other impacted solution
  • Promptly report data entry and data display issues to the team supervisor or manager
  • Actively participate in departmental and company-wide meetings
  • Adhere to all departmental and company-wide policies and procedures
  • Cross-train in other Government Programs as needed
  • Attend and present at internal meetings
  • Attend training to maintain industry knowledge

What you will bring

  • 3+ years of overall experience in U.S. healthcare industry
  • 2+ years of experience in analyzing federal and/or state government pricing for hospital and professional reimbursement
  • 2+ years of experience in Medicaid and Medicare hospital claims billing
  • Advanced proficiency of MS Office products, particularly Excel, Word, Outlook, and Edge, and PDF and text editors
  • Strong verbal and written communication skills
  • Proven ability to utilize specialty software to complete essential duties and responsibilities
  • Internet research skills
  • Meticulous attention to detail and strong focus on quality
  • Efficient time management and problem-solving skills and ability to multi-task
  • Demonstrated ability to work in a team environment that requires quick turnaround and quality output

What we would like to see

  • Medical terminology certification
  • Microsoft Office certification
  • A degree in a related field

FinThrive's Core Values and Expectations

  • Demonstrate integrity and ethics in day-to-day tasks and decision making, adhere to FinThrive's core values of being Customer-Centric, Agile, Reliable and Engaged, operate effectively in the FinThrive environment and the environment of the work group, maintain a focus on self-development and seek out continuous feedback and learning opportunities
  • Support FinThrive's Compliance Program by adhering to policies and procedures pertaining to HIPAA, FCRA, GLBA and other laws applicable to FinThrive's business practices; this includes becoming familiar with FinThrive's Code of Ethics, attending training as required, notifying management or FinThrive's Helpline when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations
Physical Demands

The physical demands and work environment characteristics described here are representative of those that a colleague must meet to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Statement of EEO
FinThrive values diversity and belonging and is proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We're committed to providing reasonable accommodation for qualified applicants with disabilities in our job application and recruitment process.

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FinThrive is an Equal Opportunity Employer and ensures its employment decisions comply with principles embodied in Title VII, the Age Discrimination in Employment Act, the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Assistance Act of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations.
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