File Maintenance-Maitland, FL

Position Summary:

The Contract & File Maintenance Department is looking for a Fee Schedule & Reimbursement Specialist who is responsible for maintaining NextGen databases and peripheral programs. Proper documentation and timely communication of ticket/project status’/needs and collaborating with numerous departments to ensure timely resolution. Specialist will need to be able to read, interpret, research, and calculate reimbursement rates. Comfortable reaching out to payers and third party sources to obtain fee schedules data.

Key Responsibilities:

·       Create, Maintain and Update Profiles in Practice Management Data Base System; Nextgen.

o   Profiles; Payer, Group, Provider, Location, Contract, CPT, Service Item/Charge Master

·       Establish and maintain standardized documentation of system change history.

·       Work and Manage OS Ticketing System.

·       Maintain Provider Supervision Linkage for Adequate Billing

·       Creates new users/ resets passwords. Establish and maintain online payor portal access for all users.

·       Develop and maintain contract / fee schedule library of NextGen documents and data.

·       Performs CPT/HCPCS code and fee schedule updates,

·       Coordinates research and responds to inquiries on fee schedule discrepancies.

·       Works with provider contracting staff when new/modified reimbursement contracts are needed.

·       Maintain provider contract linkage

·       Maintain, Analysis and Calculate and Charge Master Updates.

·       Ensure that provider reimbursements and fee schedules are loaded in PM and contracts database in accordance with contractual agreements and that provider data is current.

·       Use Web Base Web Portals to download Fee Schedules

·       Ability to read, interpret, research, and calculate reimbursement rates for adequate Fee Schedule Reimbursement.

·       Review, Analysis and Report on Contract Analysis Reports to Identify Discrepancies and Update System with Findings.  

·       Works collaboratively with peers and senior management to ensure business needs are being met.

·       Preparing recommendations for process improvement opportunities. 

Requirements:

·       Proficiency in Microsoft Word, Excel and SharePoint preferred.

o   Excel: Knowledge and use of formulas (VLookup) and Pivot Tables.

·       Time Management skills is essential.

·       Must possess strong research skills and perform well independently and in a team setting.

·       Experience with reviewing Contracts preferred.

·       Prior Knowledge of Fee Schedules preferred.

·       Ability to maintain a high level of confidentiality

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