Description: The Medicare Specialist researches, maintains, updates and creates new methodologies for Medicare payment systems to implement in Prime Health Services' (PHS) suite of products as appropriate and understands NCCI/MUE billing edits as related to Prime products.What You'll DoResearches and deciphers complex legal and regulatory sources regarding payment rules for Medicare payment systemsCollaborates with Regulatory Compliance colleagues on how Medicare rules apply to Personal Injury Protection and Workers Compensation reimbursementDrafts concise documentation for payment procedures-including payment calculation logic-and interacting with the development team to refine that documentation into user stories and project plansCreates and updates internal documentation and processes, as needed for all Medicare based productsIdentifies issues upfront and communicate clearly to team members and leadershipManages competing priorities and delivers quality information and analysis while adhering to deadlinesDevelops, manages, and maintains rules in the PHS proprietary bill review software for all Medicare payment policies and systemsReports any showstopper issues to the Director of CompliancePerforms unit and acceptance testing as necessaryPerforms other duties as assigned Requirements: Bachelor's Degree in health care administration, business and/or other related discipline (Related experience in a health care administration setting may be substituted for educational requirements)Outpatient Coding Credential (Certified Professional Coding (CPC), Certified Outpatient Coder (COC), or Certified Coding Specialist- Professional (CCS-P) are preferredProficient computer skills - expert knowledge of Microsoft Office Suite (Excel, Word, PowerPoint)2+ years of relevant work experience (physician practice, hospital, ancillary provider, health insurance company or integrated delivery system) is preferredKnowledge of ICD-10CM, CPT4, Revenue Codes, DRGs, base rates, HCPCS coding, Medicare regulations, payment policies, OPPS, and related governmental guidelines and provider reimbursement methodologies are requiredCompetenciesExcellent planning, communication (oral and written), documentation, and organizational abilitiesAdvanced mathematical, analytical, and problem-solving skillsAbility to interpret and summarize results of various analyses in a timely and meaningful wayAbility to work cooperatively with multidisciplinary teams and/or independentlyWhy You'll Love Working At PHSMedical Insurance (high deductible plan with an HSA)Dental InsuranceVision InsuranceShort-term and long-term disability paid by the companyGroup term life paid by the companyGenerous PTO Policy Employee recognition programsCorporate office amenities Regular employee events About PHSPrime Health Services (PHS) is a national medical cost containment company with a noteworthy PPO Network used by insurance carriers, TPA's, self-insureds, and governmental entities. Our tech-focused nature allows clients to take advantage of the flexibility of customization while not compromising on bill processing speed. Since 2001, we have specialized in medical provider network development and offer clients a tailored approach to medical cost containment: quality health care at discounted rates.PIfb96aba41eb2-4146
Not specified in the original listing.
Not specified in the original listing.
