Reimbursement Specialist (272)
Commonwealth Care Alliance 17 reviews - Boston, MA

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Provider Network Management Department


Under the direction of the Manager of Behavioral Health Provider Network, the Reimbursement Specialist is responsible for supporting the Provider Network Management (PNM) department in developing and implementing reimbursement strategies for the many types of healthcare and support service providers with whom Commonwealth Care Alliance contracts. A comprehensive understanding of reimbursement methodologies and health care financing is required.

ESSENTIAL DUTIES AND RESPONSIBILITIES: · Track all contractual reimbursement methodologies, rates and fees
· Act as liaison between CCA and CCA’s claims vendor to manage workflows/exchange of information, identify and resolve problems, ensure implementation of correct fees, monitor quality
· Stay current on all applicable Medicare and MassHealth fee schedules; conduct regulatory updates
· Regularly inform PNM management of coding, fee, rate, methodology changes; initiate development of implementation plans for new codes/rates
· Conduct research on industry reimbursement trends; assess competitive intelligence for developing reimbursement strategies
· Work with CCA’s Finance department to perform ongoing financial analysis and modeling to reflect changes in coding, fees, rates, methodologies
· Identify and assist with implementation of codes for new services
· Educate and support PNM contract negotiators on reimbursement arrangements with providers
Requirements: · Bachelor’s degree
· Minimum of 3 years relevant experience
· Resourceful, effective researcher
· Knowledge of / Experience with:
- Coding and claims payment
- Health insurance plans
- Reimbursement methodologies (FFS, global, capitation, other risk-sharing)
- Medicare and MassHealth reimbursement
- Financial analysis, modeling
· Advanced proficiency with Excel
· Must be strong communicator; excellent written and verbal skills; good listener
· Excellent organizational and project management skills
· Ability to work in a fast-paced environment
· Ability to collaborate and be part of a team and communicate at all levels of the organization
· Ability to work effectively with a broad set of internal and external stakeholders

About this company
17 reviews
Commonwealth Care Alliance, Inc. (CCA) is a not-for-profit care delivery system committed to providing integrated health care and related...