What We're Looking For

• Bachelor's Degree in a related field or the equivalent combination of training and experience.
• Master's Degree or graduate work in a related field preferred.
• 3 or more years' experience in a fast paced, managed healthcare environment is required
• 3 or more years' experience and advanced knowledge of provider fee schedule, pricing and reimbursement methodologies, specifically Medicare/MassHealth methodologies, regulations, and dependent payment terms
• Experience working with Medicare/MassHealth and commercial claims coding rules/ regulatory requirements
• Medical claims auditing for payment accurate and/or contracting
• Demonstrated acumen for managing complex financial payment methodologies
• Demonstrated knowledge and solid understanding of Medicare/MassHealth
• Strong understanding of all clinical coding and billing principles associated with CPT, HCPCS, ASA,ICD-9/10, OPPS, MassHealth APR-DRG's, and NUBC revisions
• Ability to prioritize competing priorities, meet deadlines, coordinate with others to accomplish general objectives, multi-task and problem solve
• Flexible, highly motivated, self-starter individual capable of supporting multiple tasks needed, with proven ability to take ownership of project and responsibilities under minimal supervision
• Strong analytical skills
• Demonstrated proficiency using MS tools, including, with an interest or skillset to leverage reporting tools for analytical purposes
• Good communication skills, both oral and written, ability to interact well with others at all management levels
• Strong organizational skills and strong internal customer service skills