VP, Payments Compliance Officer
Texas Capital
Senior Medicaid Regulatory Pricer Analyst
Zelis
full-time
Posted on:
Location: Florida • 🇺🇸 United States
Visit company websiteSalary
💰 $71,000 - $95,000 per year
Job Level
Senior
Tech Stack
SQL
About the role
- Research and decipher regulatory sources regarding payment rules for State Medicaid programs and commercial payment arrangements
- Draft concise documentation for payment procedures and collaborate with development to create user stories and test cases
- Perform analysis of data sources including fee schedules and provider files using tools like Excel
- Interact with regulators and clients to determine and document business requirements
- Lead pricer maintenance, QA activities, audits, troubleshooting, and defect corrections
- Educate internal and client staff regarding payment systems and procedures
- Update internal documentation and oversee one or more payment systems
- Identify issues early and communicate to team and leadership
- Manage competing priorities and deliver quality information while adhering to deadlines
Requirements
- Bachelor’s degree or equivalent experience in healthcare administration, business administration, or a related field
- Five+ years of experience in Medicaid billing, reimbursement, claim payment or cost reporting
- Experience with Medicare /Medicare Advantage or commercial billing and reimbursement a plus
- Ability to manage/oversee pricer program
- Subject matter expertise in prospective payment systems and advanced reimbursement methodologies
- Strong analytical and critical thinking skills
- Ability to prioritize multiple tasks and meet deadlines with minimal supervision
- Ability to define issues, collect data, establish facts, and draw valid conclusions
- Strong research and data analysis skills
- Ability to troubleshoot production issues
- Proficient Microsoft Office skills (functions, macros, pivot tables, data validation, business requirement writing, etc.)
- Proficient writing SQL queries
- Good understanding of public and private healthcare payment systems, medical claims, standard claim coding, claim editing, contracting, preferred-provider organizations, narrow networks
- Strong communication skills, collaboration, and active listening
