What are the responsibilities and job description for the Fee Reimbursement Analyst position at Mass General Brigham?

Site: Mass General Brigham Health Plan Holding Company, Inc.

At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission—from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.

At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare — people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds – to apply.

Job Summary

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.

We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.

The Reimbursement Analyst is responsible for the maintenance, analysis, documentation, and quality review of Mass General Brigham Health Plan provider fee schedules. This position will provide support to other Mass General Brigham Health Plan staff as it relates to fee schedules, including but not limited to; researching payment methodologies, RVU pricing, responding to staff inquiries, and coordinating configuration requests as related. This position will also be responsible for the timely monitoring of state and federal regulations pertaining to reimbursement and industry trends.

Essential Functions

• Responsible for the development and maintenance of pricing source libraries, files, and fee schedules on a regular basis, using Medicare, Medicaid, NDC, and other pricing sources, in conjunction with actively monitoring both local and national industry regulations relating to fee schedules and adopted payment methodologies.

• Create reports and present written recommendations to the PNM management team on coding rules, based on industry standards and in support of MGBHP’s provider payment guidelines; including quarterly benchmark reports and fee discrepancies reports.

• Coordinate the timely configuration of fee schedule updates; including rates as well as code additions and deletions. Also, work closely with Contract Implementation Program Manager for the coordination and submission of DRG/EAPG rate updates.

• Participate in cross-functional teams as assigned, respond to payment inquiries from internal customers, and assist with initial evaluations of requested payment changes.

• Act as primary contact for Claims Operations within PNM to assist with claims resolution, including but not limited to invoice based pricing, claims project submissions, and maintain open communication pertaining to fee schedule changes which have a cross-functional impact.

• Hold self and others accountable to meet commitments.

• Ensure diversity, equity, and inclusion are integrated as a guiding principle.

• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.

• Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.

Qualifications

Qualifications: Required:

• Bachelor’s Degree or the equivalent combination of training and experience.

• 3 years of healthcare experience, 1 of which is with a payer

• SQL experience required.

• Exposure to multiple payment methodologies.

• Knowledge of Medicare and Medicaid payment methodologies.

• Minimum of three (3) years of related experience in working with RVU and reporting functions.

• Experience with CPT/HCPCS and NDC coding and pricing

• Experience/knowledge of claims adjudication processes and claims system requirements, procedures and controls.

• High level of proficiency with Microsoft Office applications Word, Excel and Access in particular.

• Managed care experience, preferably within a health insurance setting.

Preferred/Desired:

• Understanding of and familiarity with formal contract language and reimbursement terms.

• Excellent organizational skills.

• Ability and willingness to learn and master new systems.

• Strong attention to detail.

• Proven ability to communicate effectively, including written and oral communication.

• Demonstrate Mass General Brigham Health Plan’s core brand principles of always listening, challenging conventions, and providing value.

• Strong aptitude for technology-based solutions.

• Ability to inject energy, when and where it’s needed.

• Respect the talent and unique contribution of every individual, and treat all people in a fair and equitable manner.

• Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.

• Be accountable for delivering high-quality work. Act with a clear sense of ownership.

• Bring fresh ideas forward by actively listening to and working with employees and the people we serve.

Additional Job Details (if applicable)

Additional Job Description

Remote Type

Hybrid

Work Location

399 Revolution Drive

Scheduled Weekly Hours

Employee Type

Regular

Work Shift

Day (United States of America)

EEO Statement:

Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Employment Type: Full time

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