Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.


Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.


We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.


For over 30 years, Mass General Brigham Health Plan has delivered value to our members and worked to improve access to care and coverage. As a member of Mass General Brigham, MGBHP is a health plan at the forefront of innovation, advancing a highly integrated model of value-based care with one of the world's leading healthcare systems. Together, we are transforming the customer experience, keeping our members and patients at the center of everything we do. Bring your unique talents and join us as we strive to create a world where all people live healthier lives.

The Reimbursement Analyst is responsible for the maintenance, analysis, documentation, and quality review of Mass General Brigham Health Plan provider fee schedules. This position will provide support to other Mass General Brigham Health Plan staff as it relates to fee schedules, including but not limited to; researching payment methodologies, RVU pricing, responding to staff inquiries, and coordinating configuration requests as related. This position will also be responsible for the timely monitoring of state and federal regulations pertaining to reimbursement and industry trends.


Essential Functions

• Responsible for the development and maintenance of pricing source libraries, files, and fee schedules on a regular basis, using Medicare, Medicaid, NDC, and other pricing sources, in conjunction with actively monitoring both local and national industry regulations relating to fee schedules and adopted payment methodologies.
• Create reports and present written recommendations to the PNM management team on coding rules, based on industry standards and in support of MGBHP's provider payment guidelines; including quarterly benchmark reports and fee discrepancies reports.
• Coordinate the timely configuration of fee schedule updates; including rates as well as code additions and deletions. Also, work closely with Contract Implementation Program Manager for the coordination and submission of DRG/EAPG rate updates.
• Participate in cross-functional teams as assigned, respond to payment inquiries from internal customers, and assist with initial evaluations of requested payment changes.
• Act as primary contact for Claims Operations within PNM to assist with claims resolution, including but not limited to invoice based pricing, claims project submissions, and maintain open communication pertaining to fee schedule changes which have a cross-functional impact.
• Hold self and others accountable to meet commitments.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.



Qualifications

Qualifications:




Required:

• Bachelor's Degree or the equivalent combination of training and experience.


• 3 years of healthcare experience, 1 of which is with a payer
• SQL experience required.
• Exposure to multiple payment methodologies.
• Knowledge of Medicare and Medicaid payment methodologies.
• Minimum of three (3) years of related experience in working with RVU and reporting functions.
• Experience with CPT/HCPCS and NDC coding and pricing
• Experience/knowledge of claims adjudication processes and claims system requirements, procedures and controls.
• High level of proficiency with Microsoft Office applications Word, Excel and Access in particular.
• Managed care experience, preferably within a health insurance setting.



Preferred/Desired:

• Understanding of and familiarity with formal contract language and reimbursement terms.
• Excellent organizational skills.
• Ability and willingness to learn and master new systems.
• Strong attention to detail.
• Proven ability to communicate effectively, including written and oral communication.
• Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, when and where it's needed.
• Respect the talent and unique contribution of every individual, and treat all people in a fair and equitable manner.
• Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
• Be accountable for delivering high-quality work. Act with a clear sense of ownership.
• Bring fresh ideas forward by actively listening to and working with employees and the people we serve.



EEO Statement

Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment.