Employer & Individual Reimbursement Policy Manager

1. About Our Client:
This organization operates in the healthcare information and technology sector, focusing on improving the flow of health data to create a more connected system. It addresses challenges related to misalignment and friction between care providers, payers, and consumers by leveraging industry expertise and innovative technology to help reduce costs, improve risk management, quality, and support revenue growth.
2. About the Opportunity:
The Employer & Individual Reimbursement Policy Manager is an individual contributor role within the Reimbursement Policy team. This position is responsible for developing and maintaining reimbursement policies, managing project initiatives, ensuring policy alignment with third-party sources, and identifying reimbursement opportunities. The role significantly impacts the organization by ensuring accurate policy implementation and supporting initiatives that improve claims processing and reimbursement accuracy.
3. Responsibilities:
Manage professional and facility reimbursement policies for Employer & Individual and Individual Family Plans.
Collaborate with other reimbursement policy managers to maintain and implement coding and edit updates.
Lead project phases including documentation, presentations, and business requirements creation.
Analyze and manipulate large data sets.
Provide coding and reimbursement policy expertise across departments.
Ensure claims are processed according to reimbursement policies.
Review and analyze third-party reimbursement and coding standards.
Represent reimbursement policy functions and provide subject matter expertise.
Create and maintain departmental materials.
Work effectively across multifunctional teams.
Support affordability initiatives impacting multiple business segments.
Develop approaches supporting accurate coding and claims editing aligned with policies.
4. Requirements:
High School Diploma or GED.
Coding certification from AAPC (e.g., CPC, COC, CIC) or AHIMA.
Must be 18 years or older.
Understanding of facility and professional reimbursement policies.
Knowledge of CPT, HCPCS, ICD-10, and Revenue Codes.
Familiarity with CMS manuals and National Physician Fee Schedule.
Experience with editing tools such as iCES and/or CES.
Experience with platforms like UNET, USP/CIRRUS, or Facets.
Intermediate proficiency in Microsoft Word, Excel, and Outlook.
Flexibility to work full-time Monday to Friday within business hours, with occasional overtime.
5. Pay Range and Compensation Package:
The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, and other relevant factors.
6. Benefits & Perks:
401(k) contribution.
Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.

Work arrangement
Yes