Provider Reimbursement Analyst

Job Summary

A company is looking for a Provider Reimbursement Analyst who will analyze provider reimbursement fluctuations and ensure accurate capitation payments.

Key Responsibilities

• Compile and analyze weekly claim runs to explain variances and fluctuations
• Resolve provider reimbursement issues, including capitation and claim refunds
• Ensure accuracy of capitation payments by reviewing and investigating capitation data

Required Qualifications

• Bachelor's Degree or equivalent, required
• Three years of managed care and healthcare experience, preferred
• Experience in communicating with technical and business constituencies
• Ability to prepare capitation analysis reports
• Familiarity with provider reimbursement processes