Reimbursement Analyst

3 weeks ago


New York, New York, United States MetroPlus Health Plan Full time
MetroPlus Health Plan is seeking a skilled Reimbursement Analyst to join our team. As a Reimbursement Analyst, you will be responsible for investigating and resolving high-level claims-related issues. This role requires a deep understanding of various reimbursement methodologies, including skilled nursing facilities, medical groups, and post-acute bundles. You will conduct audits to review the accuracy of cost reports and payment of claims, and provide timely resolution of issues to improve engagement between the Plan and Hospital Network, Ancillary, and Community providers. You will also review inquiries from providers regarding cost report settlements, research and analyze claim processing outcomes, and identify issues to report as necessary. Additionally, you will prepare and analyze cost/business proposals and reports of findings, and make recommendations to management. This role requires strong analytical and problem-solving skills, as well as excellent communication and customer service skills. If you have a strong background in healthcare reimbursement and are looking for a challenging and rewarding role, we encourage you to apply.

**Key Responsibilities:**

* Investigate and resolve high-level claims-related issues
* Conduct audits to review accuracy of cost reports and payment of claims
* Provide timely resolution of issues to improve engagement between the Plan and Hospital Network, Ancillary, and Community providers
* Review inquiries from providers regarding cost report settlements
* Research and analyze claim processing outcomes
* Prepare and analyze cost/business proposals and reports of findings

**Requirements:**

* Bachelor's degree
* 3-5 years experience in a managed care government program claims processing/analyzing experience, working with providers in addressing reimbursement issues
* Or an Associate Degree with 5-7 years or more experience in a managed care government program claims processing/analyzing experience, working with providers in addressing reimbursement issues
* Ability to work independently to meet deadlines
* Working knowledge of and proficiency with Windows-based PC systems and Microsoft Word, Outlook, Excel, and PowerPoint, Sharepoint
* Ability to exercise tact and diplomacy and demonstrate strong customer service skills
* Ability to prepare written and oral reports and make effective presentations
* Ability to independently manage assigned workload, make decisions related to area of functional responsibility, and recognize issues requiring escalation
* Highly organized, detail oriented, dependable and professional individual
* Ability to travel to meet with Providers and their representatives

**Professional Competencies:**

* Integrity and Trust
* Customer Focus
* Functional/Technical skills
* Written/Oral Communication
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