Campus Pride Jobs

Duties & Responsibilities:

• Facilitate the Healthfirst reimbursement and billing guidelines policy process, including developing new policies, monitoring industry reimbursement policy trends, and tracking annual renewals

• Conduct industry/market research on New York Medicaid and CMS reimbursement methodologies to support creation of reimbursement and billing guidelines

• Format reimbursement policies, collaborate with stakeholders, perform editorial review, check policy references, and obtain necessary approvals

• Collaborate with the Regulatory, Compliance, Legal and key stakeholder departments to organize deliverables, prepare materials, and take minutes for committees

• Prepare reports for the Reimbursement Operating Council (ROC) and any other applicable governance committees

• Identify potential organizational risks and help facilitate process improvements

• Review the appropriate reimbursement policies, billing procedures, and make recommendations for policy creation/revision and/or committee action

• Build sustainable relationships of trust through open and interactive communication with cross-functional teams at all levels of management

• Comply with HIPAA requirements and maintain Protected Health Information (PHI) confidentiality of member, provider, medical, and departmental information

• Ensure adherence to local, state, federal, and Healthfirst specific compliance and regulatory guidelines and ensure a timely and accurate response to any requests for information or audits

Minimum Qualifications:

• Associate degree or equivalent work experience

• Experience with creation of formal policy and procedures

• Familiarity with reimbursement methodologies

• Previous compliance experience within a managed care environment

• Familiarity with reimbursement terminology

• Knowledge of CMS and/or New York State DOH reimbursement methodologies

• Experience working in a fast-paced environment that requires adapting to change while handling multiple priorities simultaneously

• Work experience requiring effective communication verbally and in writing while demonstrating good grammar, spelling, and punctuation skills

• HS Diploma or GED accredited institution

Preferred Qualifications:

• Bachelors degree or equivalent work experience

• Experience with project management

• Thorough understanding of reimbursement terminology

• Thorough understanding of Medicaid /Medicare reimbursement methodologies

• Experience presenting and communicating to cross-functional groups within an organization

• Problem-solving ability and critical thinking skills

• Experience with Microsoft Word, Excel, PowerPoint, Adobe Acrobat, SharePoint and corporate email systems

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.