HP Senior Reimbursement Analyst

Location

Quincy, MA | United States

Job description

Point32Health is currently seeking highly motivated individuals to join our organization as an HP Senior Provider Reimbursement Analyst. The Senior Provider Reimbursement Analyst is responsible for a range of activities related to hospital, physician, and ancillary reimbursement, including methodologies, operations, consultation, and support to Contracting staff.

Key Responsibilities/Duties – what you will be doing

• Develop provider fee schedules using knowledge of standard external benchmarks and Harvard Pilgrim pricing strategies. Includes general knowledge of commercial and Medicare reimbursement methodologies, monitoring of market reimbursement trends and federal reimbursement regulations, and data management/analysis.
• Provide support to Network Contracting, Payment Integrity, Health Services, and other internal departments related to Harvard Pilgrim reimbursement methods, fee schedules, policies, and Medicare methodologies.
• Operational activities including fee schedule maintenance activities, provider appeals, response to internal/external questions, research, and analysis.
• Participate in cross-departmental projects and meetings.
• Develop documentation, communication, and other informational materials.
• Perform out-of-the-box thinking, collaborate with others, and make a difference every day!
• Other duties and projects as assigned.

Qualifications – what you need to perform the job

• BA/BS degree with Masters preferred, 5-7 years of relevant experience in health care industry.
• Working knowledge of provider reimbursement methodologies, including institutional, professional, and ancillary providers. Working knowledge of standard health care code sets.
• Strong analytic skills and extensive experience with spreadsheet software.
• Ability to work independently and communicate effectively.
• Resilient, collaborative, flexible, innovative.

Commitment to Diversity, Equity & Inclusion

Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.

Req ID: R7714

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