Bachelor's degree plus three years of relevant experience or equivalent combination of education and experience.
Strong budgeting, forecasting, and variance analysis skills.
Basic proficiency in Microsoft Office, including Word, Outlook, and PowerPoint.
Intermediate level skills in Excel.
Responsibilities
Develop and monitor reimbursement and provider strategies while preparing effectiveness reports.
Analyze data to identify cost reduction opportunities and market trends.
Validate and maintain data quality and provide resolutions to identified issues.
Conduct annual reviews of compliance workflows and provider contracts.
Lead internal controls and create functional summary reports for management.
Participate in team activities by providing leadership and constructive feedback.
Benefits
Hybrid work environment offering flexibility.
Opportunities for professional development and growth.
Collaborative team culture promoting accountability and expertise.
Full Job Description
Develop, analyze, recommend, and monitor reimbursement and provider strategies; prepare reports that measure the effectiveness of reimbursement and contracting terms and the influence they may have on overall program/plan cost and utilization.
Analyze data and identify trends, patterns, or other notable issues with an eye for cost reduction opportunities.
Monitor market trends to identify emerging opportunities or risks in business environments.
Monitor websites for reimbursement and policy changes for both private and government entities; make recommendations for implementation of these changes.
Analyze standard plan or provider financial and operational reports in response to customer requirements and business needs
Lead and implement internal controls; Facilitate definition of data and other information requirements; Define efficient data assembly methods; and maintain adequate documentation for general reference and audit purposes.
Create functional summary reports for presentation to management
Validate and maintain quality and consistency of data and reporting
On a proactive basis identify and isolate potential problems and work with staff within and outside of the department to develop and implement resolutions; develop and communicate data adjustments and workarounds.
Propose resolutions to management to clearly define the increase in value and productivity associated with the changes.
Annual review of compliance workflows, such as, SSAE, MAR.
Review provider contracts and ensure that claims system set ups accurately reflect fully executed, signed agreements.
Participates and promotes team activities by providing leadership, consultation, managing other projects, sharing accountability and expertise, communicating, and improving integrity of workflows, and providing constructive feedback on other team members' performance.
Perform all other miscellaneous responsibilities and duties as assigned or directed.
#LI-Hybrid
Bachelor's degree and three years of related work experience, or an equivalent combination of education and related work experience.
Demonstrated budgeting, forecasting, and variance analysis skills
Basic knowledge of Microsoft Office applications. Including but not limited to Word, Outlook, and Power Point.
