Senior Provider Reimbursement Professional (Medicaid Claims)

TL;DR

Senior Provider Reimbursement Professional (Medicaid Claims): Managing complex and escalated healthcare claims research, adjustment, and resolution with an accent on Medicaid claims, claims systems, and data analysis. Focus on investigating variable claim factors, identifying trends, leading projects, and coordinating resolutions across multiple business areas.

Location: Remote nationwide within the United States; occasional travel to hirify.global offices for training or meetings may be required.

Salary: $59,300–$80,900 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare and health insurance company serving members through hirify.global insurance services and CenterWell healthcare services.

What you will do

• Research, investigate, and resolve broad-scale, complex, and escalated claims.
• Review claims data and processing documents to support accurate adjustments and decisions.
• Handle Medicaid claims and collaborate with multiple business areas on resolution.
• Identify trends in claims data using data analysis tools.
• Lead projects related to claims operations and reimbursement processes.
• Communicate with customers and support claims operations.

Requirements

• At least 3 years of claims research or processing experience with CAS.
• At least 3 years of experience using Mentor to review claims processing documents.
• At least 3 years of CIS or CIS Pro experience.
• At least 2 years of Medicaid claims experience.
• At least 2 years of project leadership experience.
• Experience using data analysis tools to review, interpret, and identify trends in claims data.

Nice to have

• Experience with Audit Tool.
• Experience with the EFR system (Enterprise Financial Recovery).

Culture & Benefits

• Full-time schedule of 40 hours per week.
• Home work setup requires at least 25 Mbps download and 10 Mbps upload speeds.
• Dedicated workspace required to protect member PHI and HIPAA information.
• Medical, dental, and vision benefits.
• 401(k), paid time off, holidays, parental and caregiver leave, disability coverage, and life insurance.