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About The Role
Impact you will make
As a Government Programs Specialist with FinThrive, you are responsible for the management of federal and/or state pricing systems (Medicare, Medicaid, Tricare, ChampVA, Workers Compensation, and/or 3M pricing products) for hospital and professional reimbursement for FinThrive’s Contract Manager and related solution. This role is paramount in ensuring data accuracy and reliability within FinThrive products as well as providing support to our revenue management solutions.
What You Will Do
Research and interpret federal and state regulations (Medicare, Medicaid, Tricare, ChampVA, Workers Compensation, and/or 3M pricing products) quarterly, annually, and as updates occur to determine what reimbursement has changed, inactivated, or added since previous updates were made to pricing
Check for regulatory updates on a weekly basis, at a minimum, for assigned documentation
Download and analyze reimbursement changes required
Analyze, load, and modify fee schedules, rates, and factors included individual hospital updates
Update minimum of 10 fee schedules monthly
Perform database design, development, and enhancement, as well as manage and coordinate changes to the existing pricing systems
Create test plans and execute quality assurance on newly developed or enhanced logic
Serve as backup to vendor deploy manager learning all components of that process
Successfully engage in multiple development initiatives simultaneously
Attend customer meetings as required as government pricing reimbursement subject matter expert
Review and analyze claims (protected health information – PHI) with customers to understand pricing issues identified
Update pricing logic and provide detailed specifications to the development team for pricing node changes
Respond to customer Salesforce cases in a timely manner based on documented policy
Research and close minimum of 30 Salesforce cases per month subject to volume received
Follow up verbally with customers as needed
Communicate with government agencies
Provide internal and external customer support from implementation to full adoption of Contract Manager or any other impacted solution
Promptly report data entry and data display issues to the team supervisor or manager
Actively participate in departmental and company-wide meetings
Adhere to all departmental and company-wide policies and procedures
Cross-train in other Government Programs as needed
Attend and present at internal meetings
Attend training to maintain industry knowledge
What You Will Bring
3+ years of overall experience in U.S. healthcare industry
2+ years of experience in analyzing federal and/or state government pricing for hospital and professional reimbursement
2+ years of experience in Medicaid and Medicare hospital claims billing
Advanced proficiency of MS Office products, particularly Excel, Word, Outlook, and Edge, and PDF and text editors
Strong verbal and written communication skills
Proven ability to utilize specialty software to complete essential duties and responsibilities
Internet research skills
Meticulous attention to detail and strong focus on quality
Efficient time management and problem-solving skills and ability to multi-task
Demonstrated ability to work in a team environment that requires quick turnaround and quality output
What We Would Like To See
Medical terminology certification
Microsoft Office certification
A degree in a related field
FinThrive’s Core Values and Expectations
Demonstrate integrity and ethics in day-to-day tasks and decision making, adhere to FinThrive’s core values of being Customer-Centric, Agile, Reliable and Engaged, operate effectively in the FinThrive environment and the environment of the work group, maintain a focus on self-development and seek out continuous feedback and learning opportunities
Support FinThrive’s Compliance Program by adhering to policies and procedures pertaining to HIPAA, FCRA, GLBA and other laws applicable to FinThrive’s business practices; this includes becoming familiar with FinThrive’s Code of Ethics, attending training as required, notifying management or FinThrive’s Helpline when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations
Physical Demands
The physical demands and work environment characteristics described here are representative of those that a colleague must meet to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Statement of EEO
FinThrive values diversity and belonging and is proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We're committed to providing reasonable accommodation for qualified applicants with disabilities in our job application and recruitment process.
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FinThrive is an Equal Opportunity Employer and ensures its employment decisions comply with principles embodied in Title VII, the Age Discrimination in Employment Act, the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Assistance Act of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations.