Job Description

NaphCare has an great opportunity for a MEDICARE / MEDICAID COMPLIANCE ANALYST to join our Corporate Headquarters in Birmingham, AL 35216.

The Medicare / Medicaid Compliance Analyst will research and interpret complex regulatory payment policies and claims processing guidelines for multiple Medicaid states. The ideal candidate will have a strong knowledge and previous experience of CPT, ICD-10, HCPCS, Code Modifiers as assigned by the Centers for Medicare and Medicaid Services (CMS). 

DUTIES:

• Researching and interpreting complex regulatory payment policies and claims processing guidelines for multiple payment systems such as Medicare, Medicaid (in multiple states) as well as deciphering contractual language regarding commercial payment arrangements.
• Perform data analysis tasks, which include extracting fee schedules, provider files, base rates and edits using software programs such as Microsoft Excel.  
• Assist in maintaining fee schedules and data in all systems.
• Liaison with third party pricing and editing vendors (i.e. 3M, Payer Compass, Optum).
• Educating internal staff regarding payment systems and procedures.
• Analyze claims pre and post processing to ensure fee schedules and edits are applied accurately.
• Assist in reviewing provider appeals to determine if claims paid accurately.
• Update internal documentation and processes as needed

EXPERIENCE:

• Bachelor’s degree or equivalent combination of education and applicable job experience.
• Minimum of five years of experience with Medicare/Medicaid billing, claims processing and reimbursement.
• Experience with multiple Medicaid states and provider types (i.e. hospital, professional, ambulance, DME, clinical lab, etc.) preferred.  
• Experience with Medicare billing and reimbursement; both Part A and Part B a plus. 
• Experience with working in claims payment systems; with multiple pricing and editing software (i.e. 3M, Payer Compass, Optum programs, etc.) preferred.
• Need proficiency in all Medicare levels - professional & facility (DRG)
• CPC and CPMA certification a plus.

KNOWLEDGE, SKILLS AND KEY COMPETENCIES:

Knowledge and previous experience of CPT, ICD-10, HCPCS, Code Modifiers as assigned by the Centers for Medicare and Medicaid Services (CMS) Expertise in facility reimbursement methodologies, including APR-DRG and EAPG pricing Expertise in physician reimbursement methodologies Knowledge and understanding of CCI edits, modifier payment policies, and multiple procedure rules Strong research skills Strong close-reading and analytical skills with the ability to interpret dense regulatory or procedural language Ability to define issues, collect data, establish facts and make valid conclusions

**THIS IS NOT A REMOTE POSITION.

NaphCare partners with correctional facilities to provide proactive, patient-focused healthcare.  We recognize that we serve a unique and diverse patient population, and our onsite teams take pride in bringing excellence in care to a population in great need.  Be part of a world-class team of professionals who are revolutionizing correctional healthcare. 

OUTSTANDING BENEFITS PACKAGE:

NaphCare offers competitive benefits, including health, prescription, dental, Employment Assistance Program (EAP) services, vision and 401(k). NaphCare offers term life insurance at no cost to the employee and provides PTO, paid holidays and an array of voluntary benefits. Employees enrolled in our health insurance program receive prescriptions free of charge when filled at our in-house pharmacy or mail order program.

Equal Opportunity Employer: disability/veteran

Company Description

As the leading independently-owned company in correctional healthcare, we are committed to providing quality employment opportunities for healthcare and administrative professionals. We invite you to become a valuable member of our team. NaphCare professionals aren't just employees, but important partners in our organization. We care about making a difference in the lives of others, as well as ensuring professional growth. NaphCare is one of the fastest-growing independent healthcare providers in the field, with over 1,000 medical professionals across the country. We treat each employee with care and appreciation. Equal Opportunity Employer: disability/veteran