Healthcare Reimbursement Manager

2 weeks ago

Austin, Texas, United States Health Care Service Corporation Full time
Job Summary

This role is responsible for managing the completion, adjustment, and verification of HMO, PPO, POS, and other network claims, as well as maintaining the PREMIER system and knowledge of BlueChip. The successful candidate will be responsible for preparing and delivering provider settlements and reconciling payments and claims. Additionally, this role will involve supervising staff in handling provider inquiries concerning contractual allowances and contacting healthcare providers to resolve collection issues.

Key Responsibilities
  • Manage the completion, adjustment, and verification of HMO, PPO, POS, and other network claims
  • Maintain the PREMIER system and knowledge of BlueChip
  • Prepare and deliver provider settlements and reconcile payments and claims
  • Supervise staff in handling provider inquiries concerning contractual allowances
  • Contact healthcare providers to resolve collection issues
Requirements
  • Bachelor's degree in Finance, Accounting, Computer Science, or Statistical Analysis and 5 years of Medicare audit, hospital accounting, or managed care experience
  • 1 year of management or leadership experience
  • 3 years as a primary analyst responsible for running production activities for a designated product and/or system
  • 3 years as primary liaison with providers, internal departmental, and audit inquiries
  • Knowledge of hospital and institutional provider billing, payment methodologies, financial reporting, and balancing techniques
  • Knowledge of the healthcare industry, insurance concepts, claims processing, and provider/membership systems
  • Ability to provide analytical and supervisory guidance to less experienced analysts
  • Ability to identify solutions to complex processes without assistance
  • Analytical, verbal, and written communication skills
  • PC proficiency to include Word, Excel, PowerPoint, and Outlook
Preferred Requirements
  • Knowledge in Teradata SQL, ie. Enterprise Data Warehouse
  • Knowledge of provider reimbursement methodologies for a broad spectrum of professional and provider types and specialties

This is a hybrid role requiring 3 days in the office and 2 days remote weekly. We encourage people of all backgrounds and experiences to apply. Even if you don't think you are a perfect fit, apply anyway - you might have qualifications we haven't even thought of yet.

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

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