Needs to work closely and communicate effectively with internal and external stakeholders in an ever-changing, rapid growth environment with tight deadlines. This role involves designing and analyzing the healthcare reimbursement model. Be able take up new initiatives, maintain synchrony in the team. Collaborate with external & internal stakeholders, work effectively in a growing team, be a strong team player. Be able to create and define SOP's, TAT's for ongoing and upcoming projects.
What You Will Do
- To design, analyze and maintain healthcare reimbursement models to ensure the revenue estimation is in-line with the contracts.
- To perform various analytical reviews and deep-dives (root cause analysis) on client-specific healthcare reimbursement methodology to ensure accuracy of revenue projections and actual collections.
- Ability to comprehend managed care contracts and payment methodologies such as APC, Surgical Tiering, Stop Loss, Outliers, and DRG reimbursements.
- General understanding of CMS Payment logic, including but not limited to, Medicare IPPS, OPPS, as well as various State reimbursement methods for Medicaid like programs including APR DRG and EAPG Methodologies
- Experience analyzing data in Excel, importing, and exporting data, creating Pivot tables, inserting graphs to trend data.
- To report/highlight the exceptions in reimbursement method by building contract models for Hospital charges.
- Model Validation to ensure overall accuracy of Calculation engine for sites
- To effectively communicate the findings/ observations with recommended action to US team/clients.
- Maintain MIS related to analysis, Accuracy and coverage report for maintenance databases
- Handling client calls and communicating effectively for task deliverables and site maintenance
What Will You Need
- Graduate degree Preferably in Statistics Mathematics Economics CommerceFinance from a reputed educational institute
- Strong computer skills with emphasis on Microsoft Excel, Access Database, and/or SQL
Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.
Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package. To learn more, visit: r1rcm.com
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