Requirements
- Bachelor's degree in healthcare administration, business, or a related field; relevant healthcare experience may substitute for formal education.
- Strong capabilities in planning, communication, recordkeeping, organization, analysis, and resolving complex issues.
- Proficient in advanced mathematical computations and quantitative reasoning.
- Capable of interpreting analytical outcomes and delivering concise, actionable summaries under deadlines.
- Expertise in Microsoft Excel and Access, with strong overall computer literacy.
- Skilled in collaborating across diverse teams or working autonomously as needed.
- Able to redesign workflows to enhance efficiency, accuracy, and timeliness in reimbursement operations.
Nice to Have
- Background in physician practices, hospitals, ancillary services, health insurers, or integrated healthcare networks is advantageous.
- Demonstrated familiarity with managed care systems and hands-on reimbursement experience is desired.
- Knowledge of ICD-9CM, CPT-4, Revenue Codes, DRGs, base rate structures, Medicare and Medicaid payment models, HCPCS coding, and government reimbursement guidelines is preferred.
Required (7)
- Bachelor's Degree in health care administration, business and/or other related discipline (Related experience in a health care administration setting may be substituted for educational requirements).
- Excellent planning, communication, documentation, organizational, analytical, and problem-solving abilities.
- Advanced mathematical skills.
- Ability to interpret and summarize results of various analysis in a timely and meaningful way.
- Strong computer skills, including expert knowledge of Access and Excel.
- Ability to work cooperatively with multidisciplinary teams and/or independently.
- Ability to re-engineer processes to positively impact productivity in terms of timeliness and accuracy.
Preferred (3)
- Experience with a physician practice, hospital, ancillary provider, health insurance company or integrated delivery system is preferred.
- Preferred individual will have in depth understanding of managed care delivery systems and have had direct experience with reimbursement.
- Knowledge of ICD-9CM, CPT4, Revenue Codes, DRGs, base rates, Medicare methodologies, Medicaid methodologies, HCPCS coding and related governmental guidelines and provider reimbursement methodologies preferred.
