Responsible for maintaining TUMG Master Fee Schedule, tracks payer fee schedule updates and coordinates with vendors to ensure timely and accurate uploads and performing in-depth payer reimbursement and variance analysis, supporting payer negotiations, and advising on strategic pricing decisions. This role ensures contract compliance, coordinates with A/R team to resolve over/underpayments, and supports efforts to optimize revenue cycle operations and reimbursement accuracy through collaboration with internal teams, payor relations, and third-party vendors.
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REQUIRED EDUCATION AND EXPERIENCE:
PREFERRED QUALIFICATIONS:
Masters Degree: minimum four (4) years experience in healthcare setting preferred.
Demonstrated proficiency in the utilization of Data Visualization tools such as Power BI, Excel and other software for analyzing data.
Experience with hospital or clinical charge description master (CDM) and payer fee schedules; knowledge of global fees, professional fees, and technical fees; experience in medical billing, collections, and coding practices and procedures.
Deep understanding of managed care, government contracts, and reimbursement processes.
Strong data analysis skills with the ability to compile and interpret complex data sets related to contract compliance and payment trends.
Experience in Fee Schedule Analysis and Management
RVU Validation and Yearly Review and Update
Excellent communication and interpersonal skills for working with internal teams and external payer representatives.
Knowledge of medical coding systems (ICD, CPT, HCPCS, etc.) and payer fee schedules.
Oversight of Financial and Business Office staff and functions related to Revenue Cycle
Ability to maintain confidentiality in all work performed.
Excellent organizational and time management skills; ability to effectively manage multiple tasks simultaneously and meet established deadlines.
Excellent skills using MS Word, Excel and PowerPoint
Deep understanding of managed care, government contracts, and reimbursement processes.
Strong data analysis skills with the ability to compile and interpret complex data sets related to contract compliance and payment trends.
Experience in Fee Schedule Analysis and Management
RVU Validation and Yearly Review and Update
Excellent communication and interpersonal skills for working with internal teams and external payer representatives.
Knowledge of medical coding systems (ICD, CPT, HCPCS, etc.) and payer fee schedules.
Oversight of Financial and Business Office staff and functions related to Revenue Cycle
Ability to maintain confidentiality in all work performed.
Excellent organizational and time management skills; ability to effectively manage multiple tasks simultaneously and meet established deadlines.
Excellent skills using MS Word, Excel and PowerPoint