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Performs research, analysis, documentation, and interpretation for the provider reimbursement programs for an organization that provides health insurance.
Update, maintain, and review fee scheduling and pricing structures. Ensure contracted rates and reimbursement policies are priced and applied accurately.
Make reimbursement policy and process recommendations and ensure compliance with government regulations. Analyze provider reimbursement patterns and trends.
CAREER LEVEL DESCRIPTION:
Demonstrates competence in own area, and is proficient in specific area of discipline. Typically works with moderate guidance in area of knowledge.
Full application of standard policies and procedures. May still be acquiring higher skill level, and gaining exposure to more complex tasks within job function.
Provides resolutions to an assortment of problems of moderately complex scope. Job requires judgment within defined practices and procedures.
MINIMUM EDUCATION & TYPICAL EXPERIENCE OR EQUIV. COMBINATION: Works under normal supervision. Follows established procedures. Detailed instructions given for new assignments. Work is reviewed for accuracy and overall adequacy