Easter Seals Jobs

Job Description

Duties & Responsibilities:

• Drive flexible, repeatable and scalable claims configuration design and implementation processes with industry best-practices

• Engage directly with other operational teams and leaders to provide input on the scope, approach, and timing of configuration work

• Assess upstream and downstream impact of configuration and policy changes to proactively identify and mitigate risk

• Manage interdependencies across other configuration units and business areas to ensure delivery timelines and project deadlines are met

• Identify and resolve inconsistencies between system configurations and reimbursement contracts and policies

• Maintain effective and consistent configuration testing protocols and quality controls

• Manage and monitor team performance, production and quality

• Establish structure for ongoing education, training and knowledge share across team

• Prepare and present updates to the business and senior executives on configuration strategies, activities, and metrics

• Lead and support company-wide initiatives

• Work with internal and external parties to ensure claim payment logic and business rules are well understood and administered appropriately

• Actively support all Compliance and Regulatory requirements with appropriate policies, processes, reports, and audit support.

• Additional duties as assigned.

Minimum Qualifications:

• Bachelor's Degree from an accredited institution or equivalent work experience

• Proven experience in health insurance focused on claim configuration and reimbursement processes

• Proficiency in provider contract reimbursement terms and code sets (HCPCS, ICD10, DRGs, CPT, etc.), and claims processing practices

• Knowledge of medical claims and adjudication procedures, including the application of reimbursement and medical policy guidelines and contract pricing

• Knowledge of claim payment methodologies and regulatory frameworks governing health plan reimbursement methods in Medicare, Medicaid and commercial insurance markets

• Experience leading complex, technical, cross-functional programs and working with senior executives

• Experience articulating complex issues to audiences with varying levels of technical expertise

• Experience influencing leaders, breaking down barriers and managing competing priorities

• Strong problem solving and analytical skills

• Excellent communication and interpersonal skills

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.