Position Summary At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. The purpose of this position is to provide analysis as well as monitor, guide and enhance the processes related to the assessment, build and ongoing maintenance of new and existing Health Plan contracts. This role requires intra-departmental communication, process management, and collaboration with our clients, IT staff, and our Provider Services department. Responsibilities:
- Provides analysis of provider contract provisions.
- Provides professional advice as a subject matter expert and concisely summarizes in layman terms the results of the contract analytics to other department leaders.
- Establishes claim selection criteria based on contract provisions.
- Responsible for data entry of key contract elements into our proprietary system.
- Monitors and updates contract information in our proprietary system as needed.
- Collaborate with other departments to follow the provider build process to ensure all contract elements are documented appropriately.
- Identify and reconcile issues related to contract configuration errors within our claim system.
Qualifications: - Bachelor's or associate degree
- Detail-oriented, highly organized work skills
- Two plus years of claims, health care provider payment methods and or billing configuration experience.
- Extensive knowledge of contract language related to DRG and percentage of billed charges, per diem/case rate payment methodology.
- Intermediate level experience with Microsoft Word and Excel.
- Experience working with data systems.
- Experience with claims data as it pertains to the health care industry.
- Ability to build and foster relationships at all levels of the organization
- Detail-oriented, highly organized work skills
- Demonstrate initiative and performs as a motivated self-starter
- Shows adaptability through handling day-to-day work challenges confidently, willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change, showing resilience in a fast-paced high growth environment.
Remote Work Requirements - High speed internet (100 Mbps per person recommended) with secured WIFI.
- A dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
- Must be able to sit and use a computer keyboard for extended periods of time.
Benefits and perks include:
- Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
- 401(k) with Employer Match - Join the team and we will invest in your future
- Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you're not feeling well, to observe holidays.
- Wellness - We care about your well-being. From Commuter Benefits to FSAs we've got you covered.
- Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we're focused on your growth as a working professional.
Salary: 75k-85k