Note: The job is a remote job and is open to candidates in USA. TriWest Healthcare Alliance connects America’s heroes with community-based health care. The Provider Reimbursement Analyst supports reimbursement programs and cost-containment strategies by analyzing claims, utilization, provider, and medical cost data, developing insights and visualizations, and communicating findings to leadership and stakeholders.
Responsibilities
- Assesses provider payments against TriWest targets for reimbursements to include discounts and alternative payment models (APMs, e.g. pay for performance) Acquires claims data from primary or secondary data sources
- Identifies, analyzes, and interprets trends or patterns in complex claims data sets and provider data files
- Develops visualizations and presentations to summarize and explain data findings or reimbursement issues
- Evaluates the completeness and accuracy of claims data
- Works closely with Provider Services and Finance leadership and SMEs on process and quality improvement strategies and/or provider education efforts, resulting from claims data analyses and findings
- Define problems, collect claims data, establish facts, analyze claims data, and report the findings to appropriate stakeholders
- Collect, aggregate and disseminate data in understandable, digestible, and useful ways across the organization
- Will effectively present claims data information and respond to detailed claims payment or coding questions from varied internal or external groups
Skills
- Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position
- This role requires knowledge of healthcare coding and reimbursements, strong analytical skills, ability to work with large multi-dimensional sets, an ability to identify negative and positive trends, and strong communication skills that enable clear communications to leadership regarding findings
- Bachelor's degree in Business Administration, Finance, Healthcare, Information Management or equivalent experience
- 3 years' experience in healthcare analysis, data management or equivalent
- Strong knowledge of CMS coding and provider reimbursement methodologies
- Proficient in Microsoft Office suite, with an emphasis in Excel and data analysis and reporting
- Working knowledge of structured query language (SQL), and SQL Reporting Services (SRS)
- Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate
- Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach
- Ability to manage large amounts of complex information easily, communicate it clearly, and draw sound conclusions
- Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow
- Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented
- Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues
- Influence the actions and opinions of others in a positive direction and build group commitment
- Advanced analytical skills; knowledge of fundamentals of accounting and sound business processes; extensive knowledge of Microsoft Excel; proficient with Word; research and project management skills
- Quality or Process Improvement experience
- Experience with data visualization tools such as Tableau, Power BI, etc
- Government claims experience
- Work with alternative payment models
- Process diagram and documentation experience preferred
Benefits
- Remote work opportunities in AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only.
- Frequent pay raises may be considered.
- Overtime opportunities to earn even more.
- Recognition and reward programs.
- Medical, Dental and Vision Coverage
- Paid time off
- 401(k) Retirement Savings Plan (with matching)
- Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
- Tuition reimbursement
- Paid volunteer time
Company Overview