Payment and Reimbursement Manager

ABOUT YOU –

You are a person loves to lead pricing configuration activities! We need someone thrives when sourcing, reading, interpreting, designing and defining complex pricing configurations for practitioners, hospitals, clinics, nursing facilities, ancillary services and other medical service providers. In the role of Payment and Reimbursement Manager, you'll be responsible for moving forward our mission by finding the uncommon person for an uncommon goal. If you can put your signature on this, we can't wait to hear from you!

Tell us about your experience with Health Information Management.
Are you a team player and a self-motivator?
What is your experience with conducting business in a way that is a credit to a company?
We are counting on you to manage multiple projects using your problem-solving skills.
We're looking for someone UNCOMMON. What is uncommon about you?

Are you highly committed? Are you team-oriented? Do you value professionalism, trust, honesty, and integrity? If so, we can't wait to meet you.

ABOUT THE JOB –

The people you will work with are exceptional. Here is what they say about what their days look like at Signature. Here is what you can look forward to, and why you'll LOVE YOUR MONDAYS.

Perform system configuration tasks related to contracts, pricing and reimburse for healthcare claims.
Review and analyze healthcare data sets for applicability and/or changes to changes to internal process, product or data systems.
Read and analyze Medicare, VA, CHAMPVA, TRICARE data and policy including rulings, directorates, transmittals, bulletins, policy manual updates, physician fee schedule (data file).
Interpret and deliver business requirements covering reimbursement updates and payment policy changes and enhancement features for translation into software design specifications.
Create detailed excel formulas to explain and prove complex payment methodologies.
Identify claim data characters for testing of pricing configurations.
Coordinate with developers, QA, data, client service and other team members to ensure that business requirements are implemented accurately and timely.
Develop test claims for Developers, UAT and QA.
Perform configuration testing.
Develop and maintain proficiency in the Company's products (software, data) and services, including commercial contracting features as related to the specific area(s) assigned.
Experience working in the healthcare system with working knowledge of billing, compliance, and payer reimbursement guidelines/regulations.
Ability to evaluate complex pricing issues for resolution.
Ability to work independently and prioritize workload according to project goals and objectives.
Core competencies include analytical thinking, information seeking, concern for quality, teamwork.
Create and manage pricing related business requirements.
Create internal reference and training material.
Develop reporting processes to assess and analyze pricing data for accuracy and efficiencies.
Provide directions to supporting pricing team to implement or maintain configuration plans.
Act as mentor to supporting pricing team in the use of related pricing applications.
Plan and implement any software releases versions to include participating in acceptance testing.
Lead pricing related test plan development and testing activities.
Serve as a subject matter expert regarding pricing configuration and Facets.
Act as internal and external point of contact for pricing-related claims adjudication activities.

ABOUT THE BENEFITS –

We're proud to put our signature on each one of our employees. When you are a member of Signature Performance, you are a part of a solutions-based organization where the values of passion, integrity, courage, and respect are the driving forces behind all our decision-making. We trust in you to do important work and bring the best version of yourself to work every day, so we want to help you achieve a work-life balance while consistently challenging yourself.

Signature believes in fully developing each one of our Associates. We deliver a performance-driven atmosphere with competitive pay, world-class training and development classes, resources, and events, an award-winning culture where everyone thrives, and so much more.

Fully Paid Health insure for our associates
Fully Paid Life Insurance
Fully Paid Short- and Long-Term Disability
Paid Vacation
Paid Sick Leave
Paid Holidays
Professional Development and Tuition Assistance Program
401(k) program with employer match
Referral bonuses
Hybrid & Remote opportunities

ABOUT US

You are uncommon. We are, too. We are looking for people to help us in our mission of working hard at lowering healthcare administrative costs for federal government agencies, payers, and providers. At Signature, our mission is to improve the health of our clients' business and making the lives of the people we work with better. As we continue to experience exponential growth, are looking forUncommon individuals to enhance our vision. We will continue to accomplish our mission by leading with our values of Passion, Courage, Integrity, and Respect in all interactions, making us a six-time Best Places to Work organization. We need uncommon leaders with uncommon qualities to shape our uncommon culture and achieve our uncommon mission.

QUALIFICATIONS:

Bachelor's degree in healthcare, business, accounting, finance, or equivalent experience.
3+ years of Pricing Configuration in Facets/NetworX and Optum groupers;Strong knowledge in provider agreements, qualifier groups & fee schedules
Advanced proficiency in Microsoft Office suite with emphasis on Excel.
Expert knowledge of reimbursement methodologies to include PPS, per diems, fee for service, CCR, DRG and APC.
Knowledge of industry standard code setsand formats including but not limited to CPT, HCPCS, ICD, NDC, CARC, RARC, X12 and HIPAA Transaction sets.
Knowledge of medical coding and medical revenue cycle management
Proficiency in creating and executing Microsoft SQL Server queries.

Preferred:

Proficiency in using MS Office (Teams, Word, Excel, PowerPoint, Visio, Access) software applications.
Proficiency in using various Web-based and other research sources and tools.
Knowledge of claims adjudication and payment
Proficiency in TriZetto Facets®
RHIA, CPC, AMBA, CMRS, AAPC or CCB or similar certification

Requirements:

U.S. Citizenship is Required for All Positions

Work On All Positions Must Be Completed in the United States

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