Senior Business Analyst

4 weeks ago

Miami, Florida, United States Independent Living Systems LLC Full time
About Us

Independent Living Systems, LLC is a leading provider of home and community-based programs, with over 20 years of experience in managing complex healthcare services.

We offer a comprehensive range of clinical and administrative services to managed care organizations and providers, serving high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market.

Job Summary

The Business Analyst/Reimbursement Specialist, Provider Data Management is a key role in our organization, responsible for coordinating and loading all physicians, hospital, and ancillary contracts for our Medicaid and Medicare clients.

Key Responsibilities
  • Ensure data integrity of all provider set-ups and reimbursement configurations
  • Implement provider contracts and/or contract amendments and conduct claims testing
  • Program reimbursement setups applicable to contract specifications
  • Responsible for timely and accurate research of resources that update critical information on a scheduled basis
  • Assist with ad hoc projects as necessary to meet client needs
  • Create and document workflows and policies and procedures (P&Ps) as necessary
  • Participate in client implementation and conversion projects
  • Represent the department by actively participating in internal meetings, external (client) meetings, and assist in creating and maintaining all pricing setups in the claims system
Requirements
  • Associate degree minimum or equivalent experience
  • Minimum four (4) years industry experience required
  • Experience in processing UB-04 / CMS 1500 claims required
  • Familiarity and understanding of provider contracts
  • Knowledge of company's proprietary claim systems preferred
  • Must possess good understanding of claim adjudication process including ICD, CPT, HCPCS
  • Proficient knowledge of UB04 / CMS-1500 claim adjudication process, including Medicare and Medicaid reimbursement methodologies (i.e. Per Diem, PPS, FFS, APG, Capitation, etc.)
Preferred Skills
  • Excellent verbal and written communication skills
  • Computer proficiency in Microsoft applications (i.e. Excel and Access)
  • Ability to travel (infrequent)
EEO Statement

In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment.

Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities.

For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace.

Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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