Payment Policy and Reimbursement Specialist

1 week ago


Reston, Virginia, United States Health New England Full time
Job Summary

This role is responsible for ensuring the accuracy and integrity of claim payments, adhering to internal controls and regulatory requirements. The ideal candidate will have a strong understanding of healthcare reimbursement policies and procedures.

Key Responsibilities
  • Develop and maintain payment policies and procedures to ensure compliance with regulatory requirements.
  • Collaborate with internal departments to define requirements and document payment rules within the adjudication system.
  • Lead cross-departmental efforts to introduce, adopt, or modify payment policies as necessary.
  • Serve as a reimbursement expert, providing guidance on payment policies and procedures to internal stakeholders.
  • Support cost savings and overpayment recovery efforts through data analysis and policy research.
Requirements
  • Bachelor's degree with a minimum of 5 years of related experience and/or training.
  • Prior payment policy development experience required.
  • Considerable knowledge of DRG, ICD-10, CPT-4, and HCPCS coding.
  • CPC certification preferred.
  • Excellent communication and technical writing skills.
Working Conditions

This role will work in a standard office-based environment with long periods of data entry, sitting, and utilizing virtual communication tools.



  • Reston, Virginia, United States Health New England Full time

    Job SummaryThis position is responsible for maintaining and adhering to internal controls, ensuring compliance with applicable laws and regulations, and following Health New England's entity-level policies and procedures. The position is responsible for reporting unethical or fraudulent activity related to business operations and adhering to Health New...


  • Reston, Virginia, United States CrossFire Group Full time

    Job Summary:CrossFire Group is seeking a detail-oriented and experienced Accounts Payable Specialist to join their team for a 90-day contract. The ideal candidate will have a strong background in managing the accounts payable process, ensuring timely and accurate processing of invoices, and maintaining positive vendor relationships.Key...


  • Reston, Virginia, United States CrossFire Group Full time

    Job Summary:CrossFire Group is seeking a detail-oriented and experienced Accounts Payable Specialist to join their team for a 90-day contract. The ideal candidate will have a strong background in managing the accounts payable process, ensuring timely and accurate processing of invoices, and maintaining positive vendor relationships.Key...


  • Reston, Virginia, United States Specialist Office Full time

    Job SummarySpecialist Office is seeking a highly skilled and experienced Medical Receptionist to join our team. As a Medical Receptionist, you will be responsible for providing exceptional patient care and administrative support to our patients and staff.Key ResponsibilitiesFront Desk OperationsManage patient flow and ensure a smooth check-in and check-out...


  • Reston, Virginia, United States Intellisoft Technologies Full time

    Job Title: Payment Configuration ConsultantLocation: Fully Remote, EST Hours RequiredDuration: 6+ Month ContractProject Overview:We are seeking a skilled Payment Configuration Consultant to assist our team in integrating and configuring new payment systems and devices. The ideal candidate will have a strong understanding of the technical aspects of payments,...


  • Reston, Virginia, United States Specialist Office Full time

    Job SummarySpecialist Office is seeking a highly skilled and experienced Medical Receptionist to join our team. As a Medical Receptionist, you will be responsible for providing exceptional patient care and administrative support to our patients and staff.Key ResponsibilitiesFront Desk OperationsManage patient flow and ensure a smooth check-in and check-out...


  • Reston, Virginia, United States Specialist Office Full time

    Job SummarySpecialist Office is seeking a highly skilled Medical Scribe to join our team. As a Medical Scribe, you will play a critical role in supporting our physicians by documenting patient notes, processing referrals, and assisting with patient communication.Key ResponsibilitiesShadow physicians and accurately document patient notes in a timely...


  • Reston, Virginia, United States Specialist Office Full time

    Job SummarySpecialist Office is seeking a highly skilled Medical Scribe to join our team. As a Medical Scribe, you will play a critical role in supporting our physicians by documenting patient notes, processing referrals, and assisting with patient communication.Key ResponsibilitiesShadow physicians and accurately document patient notes in a timely...


  • Reston, Virginia, United States ICF Next Full time

    Job Title: Senior Public Policy and Comment Analysis SpecialistICF Next is seeking a highly skilled Senior Public Policy and Comment Analysis Specialist to join our team. As a key member of our Regulatory, Policy and Economics (RPE) portfolio, you will play a critical role in supporting federal agencies by analyzing public feedback on current and emerging...


  • Reston, Virginia, United States ICF International Inc Full time

    About the RoleWe are seeking a highly skilled Senior Policy Analyst and Regulatory Specialist to join our team at ICF International Inc. This is a unique opportunity to work on high-profile projects and contribute to the development of federal policies and regulations.Key ResponsibilitiesProvide expert analysis and support on public comments received on...


  • Reston, Virginia, United States ICF International Inc Full time

    Job Title: On-Call Regulatory SpecialistICF International Inc is seeking an On-Call Regulatory Specialist to join our team. As a key member of our Regulatory, Policy & Economics (RPE) line of business, you will support the design, implementation, and improvement of federal programs.Job Responsibilities:Conduct research and analysis to support federal clients...


  • Reston, Virginia, United States Muller, Inc. Full time

    Job Title: Accounts Payable SpecialistMuller Inc is seeking a highly organized and detail-oriented Accounts Payable Specialist to join our team. The successful candidate will be responsible for providing full-cycle accounts payable support, processing vendor invoices, and assisting with routine accounting duties.Key Responsibilities:Bill Processing: Review...


  • Reston, Virginia, United States Normann Staffing Services Full time

    Pathology Billing OpportunityNormann Staffing Services is seeking a skilled Medical Claims Specialist to join their team in Ramsey, NJ. As a key member of the Revenue Cycle Management Department, you will play a crucial role in ensuring timely payment of medical claims.Key Responsibilities:Navigate claim submission and payee websites to resolve filing issues...


  • Reston, Virginia, United States ICF International Inc Full time

    Job SummaryWe are seeking a highly skilled Senior Public Policy and Comment Analysis Specialist to join our Regulatory, Policy and Economics (RPE) portfolio. As a key member of our team, you will be responsible for reviewing, processing, and analyzing public comments on highly scrutinized and often controversial public policy topics.Key...


  • Reston, Virginia, United States ICF International Inc Full time

    About the RoleWe are seeking a highly skilled Senior Public Policy and Regulatory Affairs Specialist to join our team at ICF International Inc. This is a unique opportunity to work with a global advisory and technology services provider, combining unmatched expertise with cutting-edge technology to help clients solve their most complex challenges.Key...


  • Reston, Virginia, United States J & J Worldwide Services Full time

    Job Summary**Accounts Payable Specialist**We are seeking a highly organized and detail-oriented Accounts Payable Specialist to join our team at J & J Worldwide Services. As an Accounts Payable Specialist, you will be responsible for reviewing and processing accounts payable vouchers, ensuring timely payments to vendors, and resolving any discrepancies or...


  • Reston, Virginia, United States InsideHigherEd Full time

    Position Overview:The Jimmy and Rosalynn Carter School for Peace and Conflict Resolution is in search of a dedicated Post-Award Support Specialist to enhance our post-award financial operations. This role is pivotal in assisting with the fiscal responsibilities of the department, ensuring smooth financial processes and compliance.Key Responsibilities:Fiscal...


  • Reston, Virginia, United States TPI Global Solutions Full time

    Job Title: Claims Resolution SpecialistJob Summary:TPI Global Solutions is seeking a highly skilled Claims Resolution Specialist to join our team. As a Claims Resolution Specialist, you will be responsible for interpreting and making decisions using independent judgment on complex policy coverage's and determining if coverage's apply to claims submitted.Key...


  • Reston, Virginia, United States Innovative Driven Full time

    Innovative Driven is seeking a skilled Accounts Receivable Specialist to support a dynamic law firm client in New Jersey.Key Responsibilities:Manage collections activities to resolve outstanding invoices, payments, and discrepancies.Analyze accounts receivable reports to identify issues and prioritize collections efforts.Develop effective collection...


  • Reston, Virginia, United States Commonwealth of Virginia Full time

    About the PositionThe Commonwealth of Virginia is seeking a highly skilled Policy Program Associate to join our team. As a key member of our organization, you will play a critical role in managing programs on advocacy, policy, states, and communications.Key ResponsibilitiesDevelop and implement educational resources on climate and health policy for our...