Neighborhood Health Plan (NHP) Fee Reimbursement Analyst in Somerville, Massachusetts

It’s an exciting time to be at Neighborhood Health Plan (NHP), one of the fastest growing commercial health plans in the state. Located in Somerville’s Assembly Row, our state-of-the-art building and flexible work options create a highly collaborative atmosphere. At NHP, you’ll find daily opportunities to apply your talents and contribute to our mission of ensuring equitable, affordable health care to the diverse communities we serve. NHP is a proud member of Partners HealthCare, ranked 49 out of 500 on Forbes’ 2017 America’s Best Employers List.

Position Summary: The Reimbursement Analyst is responsible for the maintenance, analysis, documentation, and quality review of NHP’s provider fee schedules. This position will provide support to other NHP 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 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 NHP’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. • Build strong customer relationships and deliver solutions that meet customer expectations; establish and maintain effective customer relationships – both internal as well as external.

Basic Requirements: • Bachelor’s Degree or the equivalent combination of training and experience. • 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. • 3 years of healthcare experience, 1 of which is with a payer • 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. • 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 NHP Core Values of Accountability, Service Excellence, Quality Care, Diversity, and forging strong Relationships. • Respect the talent and unique contribution of every individual, culture and ethnic group and treat all people in a fair and equitable manner. • Exercise self-awareness; monitor impact on others; is receptive to and seek out feedback; use self-discipline to adjust to feedback. • Accountable for delivering high quality work. Act with a clear sense of ownership. • Pre-employment background check • CORI background check, if applicable


Preferred Qualifications:* Understanding of and familiarity with formal contract language and reimbursement terms. • SQL Experience

Job: *Professional/Managerial

Organization: *Neighborhood Health Plan (NHP)

Title: Fee Reimbursement Analyst

Location: MA-Somerville-NHP - Assembly Row

Requisition ID: 3062679