Reimbursement Analyst/Architect

Company Name: CARTI
Job Location: Little Rock, AR
Job Position Type: Full Time

Job Description:
The Reimbursement Analyst/Architect, under the general direction of the Reimbursement Strategy Manager, is responsible for providing sound, high level, financial and statistical analyses to support the real-time decision-making needs of enterprise leadership. The Healthcare Reimbursement Analyst/Architect will be a strong subject-matter expert responsible for evaluating, examining, optimizing, and translating into business requirements all healthcare payor contracts for the enterprise. Primary responsibilities will also include ensuring that all claims processing and valuation systems are properly configured, maintained, and monitored constantly to ensure a high degree of compliance and accuracy with reimbursement terms and policies outlined in payor agreements. The team member, independently and within cross-functional teams, will provide highly reliable and dependable analysis and model projections for unique and new opportunities, detect improvement opportunities in existing reimbursement operations, and support the analysis, improvement, and creation of management metrics, reports, alerts, and dashboards as applicable to revenue cycle operations. Ideal candidate is expected to have a firm understanding of healthcare and payor operations, reimbursement strategies, and healthcare payor contracts and agreements.

Bachelor’s Degree in Healthcare/Finance/Accounting/Administration or Equivalent

Subject matter expert in healthcare data, with 3 + years of experience with healthcare claims, pharmacy, provider, and clinical data preferably in a Managed Care, Medicare, Medicaid or in a health plan setting.

Strong Experience utilizing payor contract and claim processing & valuation system (with experience factoring in stop-loss, case rate, carve-out, and multiple grouper rules).

3+ combined years’ experience in one or more of the following areas: Healthcare Business Office, Health Plan Payor, Government Healthcare Division, or equivalent environment.
Strong Proven experience with healthcare payor contracts and agreements.

3+ years of working knowledge of healthcare coding terminology (HCPCS, CPT, ICD9, ICD-10 CM/PCS, and Applicate Modifiers / Components)

Application Link:
Employer To Contact: Kim Wilburn
Employer Phone Number: (501) 906-2614