Payer Payment & Reimbursement Analyst

Core Competencies

Minimum Requirements

• 3-4 years of professional experience in healthcare provider payment and reimbursement.
• Working knowledge of healthcare billing, compliance, and payer reimbursement regulations.
• Experience with professional and institutional payment fee schedules, including but not limited to: Experience with Prospective Payment Systems (PPS), including: DRG, OPPS, Skilled Nursing, Home Health, Hospice, and ASC
• Experience with Prospective Payment Systems (PPS), including: DRG, OPPS, Skilled Nursing, Home Health, Hospice, and ASC
• DRG, OPPS, Skilled Nursing, Home Health, Hospice, and ASC
• Knowledge of: Critical Access, Sole Community Behavioral Health Inpatient Rehabilitation/Outpatient Rehabilitation Long Term Care Hospital Federally Qualified Health Center Physician Fee Schedule, DME/DEMPOS, Ambulance, AWP, Lab, ESRD, Hospice, Home Health, Anesthesia, ADA Integrated Outpatient Code Editor (I/OCE)
• Critical Access, Sole Community
• Behavioral Health
• Inpatient Rehabilitation/Outpatient Rehabilitation
• Long Term Care Hospital
• Federally Qualified Health Center
• Physician Fee Schedule, DME/DEMPOS, Ambulance, AWP, Lab, ESRD, Hospice, Home Health, Anesthesia, ADA
• Integrated Outpatient Code Editor (I/OCE)
• Ability to collect, research, interpret, and document complex information into clear and concise business requirements.
• Strong interpersonal and cross-functional collaboration skills.
• Working knowledge of provider types, specialties, and their applicable reimbursement methodologies.
• Ability to communicate effectively with diverse internal and external stakeholders.
• SQL reporting experience preferred.

Preferred Requirements

• Proficiency in Microsoft Office applications (Teams, Word, Excel, PowerPoint, Visio, Access).
• Experience using web-based research tools and regulatory resources.
• Knowledge of claims adjudication and payment workflows.
• Experience configuring TriZetto Facets NetworX.
• Experience configuring Optum Rate Manager.

About Us

About the Benefits

• 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 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. Our performance-driven philosophy boasts competitive pay and additional position specific incentives, where world-class training and development, resources, and events drive our award-winning culture where everyone thrives.
• Health Insurance
• Fully Paid Life Insurance
• Fully Paid Short- & Long-Term Disability
• Paid Vacation
• Paid Sick Leave
• Paid Holidays
• Professional Development and Tuition Assistance Program
• 401(k) Program with Employer Match

Security Requirements

• U.S. Citizenship or naturalized citizenship is required for this position.
• All work on all positions at Signature Performance must be completed in the continental United States, Alaska, or Hawaii.

Position Type