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Healthcare Provider Consultant #101929

Location : Jacksonville, FL
Job Type : Temp/Contract
Compensation : 56.64 USD/HOUR
Start Date : 10/16/2019
End Date : 12/31/2019
Hours : Full Time
Travel : No
Relocation : No

Job Description :

Seeking a Healthcare Provider Consultant in Jacksonville, FL! Our client company is a Major Healthcare Provider that offers services across the United States.


As a Healthcare Provider Consultant, you will be providing expertise in the design, development, and maintenance of the Provider Network Management Reimbursement systems!  

Responsibilities of a Healthcare Provider Consultant

  • Developing and maintaining provider fee schedules/internal benchmarks using knowledge of standard external benchmarks and proprietary pricing strategies.

  • Utilizing commercial and Medicare reimbursement methodologies, monitor market reimbursement trends and federal reimbursement regulations, and data management/analysis.

  • Maintaining a current working knowledge of processing rules, contractual guidelines, state/Plan policy and operational procedures to effectively provide technical expertise and business rules

  • Serving as the subject matter expert in reimbursement methodologies (industry and health plan), rules and provider billing requirements. Provide support to Network Contracting, Product,

  • Payment Integrity, Legal, Internal Audit, Revenue Program Management and other internal departments related to reimbursement methods, fee schedules, policies, and Medicare.

  • Operational activities including fee schedule/price rules maintenance activities, provider appeals, response to internal/external questions, research, and analysis.

Required Qualifications :

Requirements of a Healthcare Provider Consultant

  • Bachelor’s degree or equivalent work experience

  • 6+ years related work experience or equivalent combination of transferrable experience and education

  • Experience in Healthcare industry, with a focus on reimbursement methodologies (i.e., fee for service, capitation, DRG, per diem, etc.)

  • Knowledge of healthcare billing, claims processing, claims pricing, CPT/HCPC codes, provider payments and CMS policies

  • Demonstrated ability to achieve business results in an environment of ambiguity, challenge and constantly changing business needs

  • Must be able to communicate highly detailed and technical information in a concise and understandable way to all levels of the organization

  • Advanced level proficiency of Microsoft Office (Word, Excel and Outlook)


Perks of Working with Our Client Company (for full-time employees)

  • Excellent health plans and HSAs

  • Dental, Vision, and Life plans

  • Paid Parental Leave

  • Optional pet insurance

  • 401K plan

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