Healthfirst

The Senior Reimbursement Analyst is the subject matter expert on all aspects of reimbursement methodologists (Hospital, Physician, Ancillary, and MTLC) and therefore, is expected to support and advise management on all aspects of reimbursement including complex regulations and payment methodologies. This individual would also serve as a primary contact with auditors and other departments. The individual at this level is expected to embody Healthfirst Culture Drivers and fulfill his/her role in helping the organization meet its strategic goals.

Duties & Responsibilities: Lead cross-functional implementations including applicable testing and results verification before sign-off and Production. Identify and lead the implementation of medical cost savings opportunities through analytical skills, process improvement and innovative solutions. Take on the role of subject matter expert in claims configuration business rules including reimbursement methodologies (Hospital, Physician, Ancillary & MLTC). Lead post implementation accuracy of claims configuration implementations and mass claim adjudication projects. Lead the on-going audit of new and existing claims business rules within the claims processing system. Support and advise management on all aspects of claims configuration business rules related to complex regulations and claim payment methodologies. Lead, plan, direct and coordinate activities of others (non-direct reports) to meet claims configuration deadlines. Serve as a primary contact for auditors. Complete other projects and duties as assigned. Minimum Qualification: Associate’s degree from an accredited institution or equivalent work experience Claims Implementation Analyst or similar work experience Leadership experience consisting of coaching, mentoring and developing a team of direct reports Experience in roles that required business insight, critical evaluation and independent judgment to evaluate situations and avoid issues Experience gathering and communicating complex business requirements in a simple and easy to understand manner to executive management and multiple stakeholders Experience in working and leading cross-functional and level team members in claims configuration deliverables Experience in training new employees on departments policies and procedures Ability to plan, prioritize and organize workload of analysts while working under pressure with short deadlines Demonstrated ability to exercise good judgment and work with independence and initiative as well as strong ability to work closely as a team member. Preferred Qualifications: Bachelor’s degree from an accredited institution. Knowledge of Medicare and Medicaid reimbursement principles. Understanding of government payment systems (DRGs, APG, APC, etc. Experience working with SAS, SQL Excellent written and oral communication and interpersonal skills Compliance & Regulatory Responsibilities: N/A License/Certification: NA

Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $65,600 - $94,775 All Other Locations (within approved locations): $58,300 - $86,700 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.