Provider Reimbursement Specialist

This is a Fully Remote Job About Our Client:The organization operates in the healthcare sector, focusing on improving health outcomes by connecting individuals with care, pharmacy benefits, data, and resources. It addresses challenges in healthcare delivery through technology and data-driven solutions, aiming to advance health equity on a broad scale. About the Opportunity:The PROVIDER REIMBURSEMENT SPECIALIST role is focused on supporting the organization's reimbursement methodologies and policies. This position plays a key part in managing fee schedules, provider rates, and claim pricing, ensuring accuracy and compliance in reimbursement processes. The role contributes to operational efficiency and cost management by analyzing claims, developing business rules, and supporting contractual agreements. Responsibilities:Research and develop business rules for reimbursement methodologies and policies.Develop and submit fee schedules and provider rates to claim pricing platforms.Conduct post-load quality reviews and provide corrections as necessary.Write technical specifications or business requirements for applications and system enhancements.Perform and review user acceptance testing for relevant applications.Draft internal operational and reimbursement policies.Collaborate with business partners to develop provider agreements and payment appendices.Identify opportunities to improve operating efficiencies and medical cost savings.Monitor state fee schedule changes and ensure pricing is updated in systems.Perform additional duties as assigned. Requirements:High School Diploma or GED.Minimum of 1 year supporting professional reimbursement research and analysis.At least 1 year experience working on CSP FACETs.Minimum 6 months experience with provider contracts and interpretation of state requirements including RFPs and contracts.Intermediate to advanced proficiency in Microsoft Excel and Word.Access to a quiet, secure home workspace capable of protecting PHI.Residence with access to approved high-speed internet. Preferred Qualifications:Experience in medical billing, claims processing, or contract installation.Claims processing or resolution experience.Ability to manage multiple concurrent projects with quality and timeliness.Experience training others.Exposure to provider contracts.Undergraduate degree or equivalent. Soft Skills:Ability to work independently and collaboratively with sound judgment.Effective communication and organizational skills.Capacity to multitask and prioritize in a fast-paced environment. Pay Range and Compensation Package:The hourly pay for this role ranges from $29.00 to $52.00 per hour based on full-time employment. Benefits & Perks:Paid Time Off and 8 paid holidays.Medical plan options with Health Spending or Health Saving Accounts.Dental, Vision, Life and AD&D insurance, with short-term and long-term disability coverage.401(k) Savings Plan and Employee Stock Purchase Plan.Education reimbursement.Employee discounts.Employee assistance and referral bonus programs.Voluntary benefits including pet, legal, and long-term care insurance. Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.