Healthcare Reimbursement Specialist

4 days ago


Franklin, Tennessee, United States Inception Fertility Corporate Services Full time
About the Role

As a key member of our team at Inception Fertility Corporate Services, you will play a critical role in ensuring timely and accurate reimbursement for Managed Care Payer Contracts. This position requires strong analytical skills, attention to detail, and effective communication with various stakeholders.

Key Responsibilities:

  • Data Management: Collect and maintain accurate data regarding contract rates from payors, utilizing platforms like Availity, NaviNet, payer portals, CMS, and internal systems.
  • Reimbursement Rate Verification: Ensure organization platforms accurately reflect reimbursement rates by payer source per applicable contract terms and fee schedules, impacting net revenue calculations, contract performance, and financial planning.
  • Documentation and Tracking: Document and update tracking tools and files in compliance with required version-controlled fee schedule format and system build requirements, as well as any other impactful payment information, annually or as needed.
  • Payer Contract Compliance: Assist in monitoring payer contract compliance based on negotiated rates, communicating trends and discrepancies to Payer Relations leadership as necessary.
Your Qualifications

We are seeking an experienced professional with 3-5 years of experience in healthcare contracting, implementing/building fee schedule/reimbursement terms, billing system analytics, supporting, and maintaining reimbursement terms within Patient Management Systems.

You must have:

  • Strong Analytical Skills: Ability to navigate complex payment methodologies and identify trends and discrepancies.
  • Effective Communication: Strong interpersonal skills to communicate with Executive Leadership, Managed Care, Accounting/Finance, and RCM members.
  • Technical Expertise: Proficiency in platforms like Availity, NaviNet, and internal systems.
About Our Offerings

We provide a comprehensive benefits package, including health, vision, and dental packages, HSA/FSA, Life and Disability Insurance, and continuing education reimbursement.

Estimated Salary Range: $85,000 - $110,000 per year, depending on location and experience.



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