Medical Reimbursement Analyst

Job Summary

Focusing on provider pricing configuration, the full-time Medical Reimbursement Analyst will evaluate, design, test, and perform configurations to meet business requirements for provider contracts in a remote work environment.

Key responsibilities

• Analyze provider contracts and develop business requirements for pricing configurations
• Configure and test pricing methodologies to ensure accuracy and claims auto adjudication
• Consult with relevant teams to interpret contract intent and resolve issues related to pricing configurations

Required qualifications

• Bachelor's degree in computer science or a healthcare-related field, or equivalent work experience
• 1-3 years of experience in the health insurance industry, preferably with a strong medical claims background
• 2-4 years of experience in pricing configuration, ideally in Facets and NetworX
• Demonstrated knowledge of pricing methodologies, including Medicare and Medicaid
• Strong MS Excel skills and proficiency in medical coding