Payment Policy and Reimbursement Specialist

2 weeks ago

Springfield, Massachusetts, United States Health New England Full time
Job Summary

We are seeking a highly skilled Payment Policy and Reimbursement Analyst to join our team at Health New England. This role is responsible for ensuring the accuracy and integrity of claim payments, as well as developing and maintaining payment policies and procedures.

Key Responsibilities
  • Develop and maintain payment policies and procedures to ensure compliance with regulatory requirements and industry standards.
  • Lead cross-departmental teams to introduce, adopt, or modify payment policies as necessary.
  • Serve as the company's reimbursement expert, providing guidance on payment policies and procedures.
  • Collaborate with internal departments to define requirements and document payment rules within the adjudication system.
  • Coordinate payment policy efforts with other internal initiatives to ensure alignment with current system configuration, medical policy, or member/provider documentation.
  • Provide expert guidance to HNE providers and internal departments on billing issues and appeals related to payment reimbursement policies and inquiries.
  • Assist contracting and provider relations with communication to providers related to payment policies and methodologies.
Requirements
  • Bachelor's degree with a minimum of 5 years of related experience and/or training; or an equivalent combination of education and experience.
  • Prior payment policy development required.
  • Considerable knowledge of DRG, ICD-10, CPT-4, and HCPCS coding.
  • CPC certification preferred.
  • Prior health claims adjudication experience preferred.
  • Excellent communication skills (both verbal and written), with vendor, client, and internal stakeholders.
  • Strong technical writing, critical thinking, problem solving, and conflict management skills.
  • Able to handle multiple assignments/responsibilities simultaneously, ensuring appropriate organization and prioritization of such responsibilities.
  • Math and decision-making skills are important for assisting in the selection of vendors that best fit the company's needs.

  • Customer Service Office Specialist

    1 month ago

    Springfield, Massachusetts, United States Bob's Discount Furniture Full time

    Location: Position: Customer Service Office Specialist at Bob's Discount Furniture Experience: Not Specified Job Overview: As a Customer Service Office Specialist, you will play a vital role in the success of Bob's Discount Furniture. Our specialists are dedicated to providing a warm and respectful experience for our customers, embodying the principles of...

  • Developmental Specialist

    4 weeks ago

    Springfield, Massachusetts, United States Thom Child And Family Services Full time

    Job Title: Developmental SpecialistThom Child and Family Services is seeking a highly skilled Developmental Specialist to join their team. As a Developmental Specialist, you will play a critical role in providing early intervention services to infants and toddlers who have or are at risk for developmental delays and their families.Key...

  • Tax Compliance Specialist

    3 weeks ago

    Springfield, Massachusetts, United States HonorVet Technologies Full time

    Job Title: Tax Compliance Specialist At HonorVet Technologies, we are seeking a highly skilled Tax Compliance Specialist to join our team. As a Tax Compliance Specialist, you will play a critical role in ensuring the accuracy and timeliness of tax filings and payments for our clients. Responsibilities: * Support tax functions and special projects related...

  • Billing Specialist

    1 month ago

    Springfield, Massachusetts, United States Greater Springfield Senior Services, Inc. (GSSSI) Full time

    Job SummaryGreater Springfield Senior Services, Inc. (GSSSI) is seeking a highly skilled Billing Specialist to join our team. As a key member of our Fiscal Department, you will be responsible for managing the billing process for various programs, including MassHealth, Senior Care Options, and Medicare.Key ResponsibilitiesProcess and Submit Billing: Process...

  • Developmental Specialist

    3 days ago

    Springfield, Massachusetts, United States Thom Child And Family Services Full time

    Job Title: Developmental SpecialistThom Child and Family Services is seeking a highly skilled Developmental Specialist to join their team. As a Developmental Specialist, you will play a critical role in providing early intervention services to infants and toddlers with developmental delays and their families.Job Summary:The Developmental Specialist will be...

  • Developmental Specialist

    1 week ago

    Springfield, Massachusetts, United States Thom Child And Family Services Full time

    Join Our Team as a Developmental SpecialistWe are seeking a highly skilled and compassionate Developmental Specialist to join our team at Thom Child and Family Services. As a Developmental Specialist, you will play a vital role in providing early intervention services to infants and toddlers with developmental delays and their families.Key...

  • Developmental Specialist

    2 weeks ago

    Springfield, Massachusetts, United States Thom Child And Family Services Full time

    Early Intervention Specialist OpportunityThom Child and Family Services is seeking a dedicated and compassionate Early Intervention Specialist to join their team. As an Early Intervention Specialist, you will play a vital role in providing home and community-based early intervention services to infants and toddlers who have or are at risk for developmental...

  • Developmental Specialist

    2 days ago

    Springfield, Massachusetts, United States Thom Child and Family Services Full time

    Job Title: Developmental SpecialistThom Child and Family Services is seeking a highly skilled and compassionate Developmental Specialist to join our team. As a Developmental Specialist, you will play a vital role in providing early intervention services to infants and toddlers with developmental delays and their families.Job Summary:We are looking for a...

  • Developmental Specialist

    3 weeks ago

    Springfield, Massachusetts, United States Thom Child And Family Services Full time

    Job Title: Developmental SpecialistThom Child and Family Services is seeking a highly skilled and compassionate Developmental Specialist to join our team. As a Developmental Specialist, you will play a vital role in providing early intervention services to infants and toddlers who have or are at risk for developmental delays and their...

  • Developmental Specialist

    3 weeks ago

    Springfield, Massachusetts, United States Thom Child And Family Services Full time

    Early Intervention Specialist OpportunityThom Child and Family Services is seeking a dedicated and compassionate Early Intervention Specialist to join our team. As a key member of our multidisciplinary team, you will work closely with families and young children to provide individualized and culturally sensitive services.Key Responsibilities:Conduct...

  • Early Intervention Specialist

    4 weeks ago

    Springfield, Massachusetts, United States Thom Child And Family Services Full time

    Job DescriptionJob Title: Developmental SpecialistJob Summary:Thom Child and Family Services is seeking a highly skilled and compassionate Developmental Specialist to join our team. As a Developmental Specialist, you will play a critical role in providing early intervention services to infants and toddlers with developmental delays and their families.Key...

  • Travel Nurse RN Specialist

    4 weeks ago

    Springfield, Massachusetts, United States Triage Staffing Full time

    Job Title: Travel Nurse RN SpecialistJob Summary: Triage Staffing is seeking a skilled Travel Nurse RN Specialist to join our team in a Telemetry Nursing Position. As a Travel Nursing Opportunity, you will have the chance to work in a dynamic and challenging environment, providing high-quality patient care and contributing to the success of our healthcare...

  • Travel Nurse RN Specialist

    4 weeks ago

    Springfield, Massachusetts, United States Triage Staffing Full time

    Job Title: Travel Nurse RN SpecialistJob Summary: Triage Staffing is seeking a skilled Travel Nurse RN Specialist to join our team in a Telemetry Nursing Position. As a Travel Nursing Opportunity, you will have the chance to work in a dynamic and challenging environment, providing high-quality patient care and contributing to the success of our healthcare...

  • Customer Service Associate

    3 weeks ago

    Springfield, Massachusetts, United States City of Springfield, Massachusetts Full time

    Job SummaryWe are seeking a highly organized and detail-oriented Collections Specialist to join our team at the City of Springfield, Massachusetts. As a key member of the Collections Department, you will be responsible for ensuring accurate and timely cash collections and disbursements.Key ResponsibilitiesCollect and process payments from customersManage...

  • Hospitality Specialist

    2 days ago

    Springfield, Massachusetts, United States VIABILITY, INC Full time

    Job SummaryWe are seeking a skilled and compassionate Hospitality Specialist to join our team at VIABILITY, INC. As a key member of our Clubhouse team, you will play a vital role in supporting individuals with disabilities in achieving their goals and living fulfilling lives.Key ResponsibilitiesAssist individuals with mental illness in accomplishing work of...

  • Travel Nurse ICU Specialist

    3 weeks ago

    Springfield, Massachusetts, United States Anders Group Full time

    Job Title: Travel Nurse ICU SpecialistAnders Group is seeking a skilled Travel Nurse ICU Specialist to join our team for a travel nursing job in a reputable healthcare facility.Job Requirements:Specialty: ICU - Intensive Care UnitDiscipline: RNEmployment Type: TravelShift: 12 hours, nightsHours per week: 36Duration: 13 weeksWe offer a competitive...

  • Provider Support Specialist

    1 week ago

    Springfield, Massachusetts, United States Health New England Full time

    Job SummaryContribute to the success of the Provider Experience team by ensuring specific individual goals, plans, and initiatives are executed in support of the team's business strategies and objectives. Ensure all activities conducted are in compliance with governing regulations, internal policies, and procedures.Key ResponsibilitiesChampion a...

  • Dialysis Nurse Specialist

    4 weeks ago

    Springfield, Massachusetts, United States Healthcare Support Full time

    Job Title: Dialysis Nurse SpecialistJob Type: Local ContractLocation: Springfield, MassachusettsJob Description:Job Summary:We are seeking a skilled Dialysis Nurse Specialist to join our team at Healthcare Support. As a Dialysis Nurse Specialist, you will be responsible for providing high-quality patient care in a dialysis setting.Responsibilities:Provide...

  • Travel Nurse RN

    1 month ago

    Springfield, Massachusetts, United States Host Healthcare Full time

    Job DetailsJob Title: Travel Nurse RN - Telemetry SpecialistJob Type: Travel NursingSpecialty: TelemetryDiscipline: Registered Nurse (RN)Shift: 12 hours, nightsHours per Week: 36 hoursDuration: 18 weeksEmployment Type: TravelAbout the JobHost Healthcare is seeking a skilled Travel Nurse RN - Telemetry Specialist to join our team. As a Traveling RN -...

  • Dialysis Nurse Specialist

    4 weeks ago

    Springfield, Massachusetts, United States Healthcare Support Full time

    Job Title: Dialysis Nurse SpecialistJob Type: Local ContractLocation: Springfield, MassachusettsJob Description:Job Summary:We are seeking a skilled Dialysis Nurse Specialist to join our team at Healthcare Support. As a Dialysis Nurse Specialist, you will be responsible for providing high-quality patient care in a dialysis setting.Responsibilities:Provide...