Sr. Reimbursement Analyst - Verity

Qualified candidates will have a background that includes experience in healthcare claims reimbursement. This role will require strong attention to detail and the ability to research and implement complex provider contract reimbursement structures. The best qualified candidate will bring their healthcare background with the willingness and ability to learn several unique internal and vendor processes and systems.  

Roles & Responsibilities  

Become knowledgeable of and maintain proficiency in different vendor systems  

Lead in the development and maintenance of complex fee schedule reimbursement structures  

Manage and maintain all provider fee schedules   

Act as subject matter expert to investigate and independently resolve provider contract reimbursement issues  

Identify trends, drive change to improve operations, and mitigate potential issues with medical claims repricing  

Perform daily claims review tasks and use claims data to ensure provider demographic and rate information is loaded correctly in our PDM (Provider Data Management) system  

Create and update cross-functional teams as applicable and coordinate training  

Assist other departments with transactions and/or requests in the work queue, if needed  

Key Performance Indicators (KPI’s) for the new FMPRicing System  

Build and/or oversee the creation of all provider rate exhibits, including professional fee schedules and facility/hospital rates.  

Assist the claims team with reimbursement-related questions and provider pricing inquiries  

Audit repriced claims to confirm professional and facility claims are pricing correctly.  

Develop expertise within the contract modeling tool to provide meaningful analytics to the leadership team.  

Preferred Skills  

A qualified candidate will be a self-starter who has strong attention to detail. Time management and follow-through are important assets in this position. The individual’s ability to work both independently and to communicate and collaborate in a team environment will be essential to succeed in this position. Candidates with a similar role today and background that includes advanced knowledge and use of Excel will be advantaged.  

Qualifications and Education Requirements  

Bachelor’s degree in related field is preferred   

5 years’ experience in the health care industry working in same or similar role  

5 years’ experience in code set management and understanding provider reimbursement structures  

Exceptional communication and customer service skills  

Relationship builder who shows an ability to establish and maintain positive and effective work relationships with internal and external customers  

Ability to meet strict deadlines by re-prioritizing work when needed  

Organized – able to prioritize, coordinate, and manage a large workload with solid results  

Knowledgeable and proficient use of software products such as SharePoint, Access, PowerPoint, Excel, Outlook, and Word  

Job Requirements  

Maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA)  

Comply with all company policies  

Company Information  

Verity HealthNet is committed to revolutionizing the way healthcare is delivered by making a positive impact on the lives of patients and providers alike. We believe in a diverse, inclusive workplace and are always looking for creative, analytical, innovative, and passionate thinkers and doers who are driven to learn as well as succeed. Choosing to work for Verity HealthNet means being part of a team that values collaboration, candor, and integrity.   

Verity HealthNet is a company that fosters a supportive work environment where employees are encouraged to contribute their unique perspectives and ideas and have the opportunity to be at the forefront of groundbreaking healthcare solutions. By investing in our workforce, Verity empowers its employees’ growth and development by offering competitive hourly/salary wages and career progression. We help support our employees’ career initiatives, both professionally and personally, while maintaining a healthy work/life balance.   

A career at Verity HealthNet offers an exceptional opportunity to be part of a forward-thinking organization that is transforming healthcare. With a supportive work environment, a commitment to innovation, a focus on employee growth and culture, and a dedication to improving healthcare outcomes, Verity HealthNet is an ideal choice for individuals passionate about making a meaningful difference in the healthcare industry, leading to a tangible impact on the lives of patients and their communities  

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