Fee Schedule Specialist (Medicare Reimbursement)

POSITION SUMMARY: 

 

The Fee Schedule Specialist is responsible for updating all fee schedules in all systems with the appropriate Medicare reimbursement.  Research and address reimbursement inquiries in a timely basis.  Respond to requests and address both routine and complex reimbursement issues.  Responsible for providing timely information on provider pricing inquiries.  Support all PDM activities related to new system implementation. 

 

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

 Examine and review provider reimbursement for accuracy and thoroughnessAble to meet deadlines in a fast paced claims environmentKeep up to date on all changes with Medicare reimbursementDocument updates to all fee schedulesParticipate in provider contract testingSupport team by enhancing the quality of the databaseEfficiently and accurately assist with analyzing payments to determine trends and improvement needsAssist with process improvements by providing feedback Perform research and bring to resolution provider reimbursement issuesProvide support for all provider reimbursement activities related to new system implementationRespond to provider inquiries relating to pricing claimsAct as the liaison between departmentsAnalyze reimbursement inquiresDetermine other providers possibly impactedStrong documentation skillsMINIMUM QUALIFICATIONS:

 1-2 years Medicare fee schedule experienceHS diploma or General Education Degree (GED) requiredBachelor’s degree or business education preferred5+ years Medicare related healthcare experience

KNOWLEDGE, SKILLS AND ABILITIES:

 Extensive knowledge of Medicare (Part A, Part B, Vision, Dental and DME)Ability to read and understand Medicare guidelinesMedical TerminologyKnowledge of CPT, HCPC, Revenue, DRG and ICD9 CodingStrong analytical skillsOutstanding interpersonal skillsStrong verbal and written communication skillsAbility to work independently or with little supervisionExcellent organizational /attention to detail requiredAbility to meet deadlines and manage multiple priorities Effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environmentAbility to handle confidential information with professional ethics and integrity·  High level of proficiency with Microsoft Excel·  Proficient with Microsoft office products (including Outlook and Word)Detail oriented·  Strong data entry skills requiredAbility to effectively communicate with providersAble to work on and interact with a teamAbility to communicate with all levels of managementPresentation skills preferred

·  Ability to make sound decisions with little input from management on what needs to be done based on clearly established guidelines