Medical Reimbursement Analyst at Notable Systems Inc

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Full Time

Start Date

Immediate

Expiry Date

09 Mar, 26

Salary

80000.0

Posted On

09 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Billing, Medicare Coverage Criteria, Analytical Skills, Cross-Functional Collaboration, Testing, Quality Assurance, HIPAA Compliance, Microsoft Office, Google Suite, Document Management, Rule Development, Policy Interpretation, Customer Collaboration, Software Development, Healthcare Policies, Data Analysis

Industry

technology;Information and Internet

Description

Company Summary: We are a rapidly growing, fully remote Intelligent Document Processing company that drives unmatched efficiency in the medical equipment, healthcare, and financial services industries. Leveraging techniques like optical character recognition, machine learning, and large language models, our platform empowers our customers to transform complex, unstructured data into actionable insights, expediting their revenue cycle and lowering their costs. Ultimately, this helps patients get the care they need more quickly while reducing frustration with both their provider and their insurance company. While we currently focus primarily on the HME (Home Medical Equipment) and DME (Durable Medical Equipment) industries, we are exploring and developing additional applications of our solutions to broader problems within healthcare, finance, and beyond. Position Summary: We are seeking a detail-oriented and experienced Medical Reimbursement Analyst with expertise in ankle, foot, knee, and spine orthotics to join our team. Reporting to the Manager of Healthcare AI Solutions, you will play a crucial role in maintaining the accuracy of our proprietary payor criteria rule system by creating and updating payor rules for DME and HME products. Job Duties: Rules Development Identify and review government and payor coverage criteria policy associated with clients’ needs and requests. Analyze payor policy guidelines and break them down into comprehensive rule sets, capturing dependencies and nuances. Interpret and document coverage criteria policy guidelines by HCPC, ICD10, and other written requirements. Apply customer specific exceptions and interpretations to the rule sets. Cross Functional Collaboration Collaborate with customers to understand their specific requirements, exceptions and interpretations to apply to the policy. Collaborate with a team of software coders to convert the documented rules into code-based rules. Act as a liaison between the coder team, customers, and other stakeholders to clarify requirements and ensure accurate rule implementation. Testing Perform extensive testing of the implemented rules to ensure adherence to payor policies and accurate medical necessity determination. Prepare test files including redacting, merging and splitting PDFs, TIFs, and CSV files as needed. Create testing plans per product category to ensure comprehensive testing and rule set accuracy. Perform ongoing quality assurance audits of rule sets that have been deployed. Monitoring Stay up-to-date with healthcare policies, compliance, industry trends, and best practices related to DME and HME products. Monitor system output and coverage criteria policy rule changes that may impact results. Required Qualifications: At least 3 years of experience (within the last five years) in claims billing to Medicare for foot, ankle, knee, and spine orthotics. Deep familiarity with Medicare coverage criteria for foot, ankle, knee, and spine orthotics. Strong written and verbal communication skills. Demonstrated ability to work cross-functionally. Outstanding analytical skills with the ability to interpret complex policy guidelines and break them down into actionable data. Strong knowledge of HIPAA and PHI compliance. Proficient in Microsoft Office and Google Suite. Ability to thrive in a fast paced environment. High School degree or equivalent. Must live in the U.S. or U.S. Territories. Must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment visa at this time. Preferred Qualifications: Experience in claims billing to Medicare for hip orthotics. Experience working with software development teams. Bachelor’s degree. Experience redacting, merging and splitting documents. Salary The salary range for this job is $65,000 - $80,000 per year. Benefits: We offer comprehensive and competitive benefits, including: 10 company holidays per year 4 weeks of vacation per year 8 sick days per year Health/dental/vision insurance 401K with company match Paid parental leave Work from Home Requirements: Reliable Internet: Minimum download speed of 50 mbps and upload speed of 10 mbps. You can test your internet speed at this link: https://www.speedtest.net Smartphone: Must have a smartphone, as we use multi-factor authentication for logging in to our system, so you will need to download an app to your phone. Equipment: Company laptop and optional external monitor will be provided. Privacy: Must have a private place to work in order to protect the confidentiality of the patient data we access.

Responsibilities

The Medical Reimbursement Analyst will maintain the accuracy of the proprietary payor criteria rule system by creating and updating payor rules for DME and HME products. This includes collaborating with customers and software coders to ensure accurate rule implementation and performing extensive testing.