Healthcare Provider Consultant #101929
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.
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