Statement of the Position :

The Fee Schedule Specialist works as a Payer Relations team member. The payer relations team is a multidisciplinary group that is charged with contracting, credentialing, issue resolution and other financial processes.

This is a position that requires solid analytical skills and sound judgment. Daily activities include maintaining company databases, performing data / rate analysis and loading fee schedules.

In addition the role is responsible for analysis of medical payment rates and fee schedules, partnership with a multidisciplinary team to interpret existing and develop new fee schedules and payment rates for medical services.

Perform modeling, impact analysis and audits for all items impacted by fee schedules. Serve as subject matter expert in all areas of fee schedules, rate reimbursement, etc.

Work under direct supervision of the Payer Relations Manager.

Company Description :

At all levels, working at National Seating & Mobility provides the opportunity to directly impact our client’s lives by giving them self-reliance and independence.

Our teams are comprised of passionate individuals, dedicated to providing the best care to each client. We focus on abilities by leveraging technology and creating mobility solutions that are as unique as our client’s needs.

Working at National Seating & Mobility is an opportunity to build a meaningful career, while leaving a lasting impact on the lives of those we serve.

Located in more than 40 states, we strive for diversity and offer an array of benefits including 401k, company paid Long Term Disability, and tuition reimbursement.

We are looking to grow our enthusiastic and engaged team at NSM. Submit your resume and join a group of enthusiastic professionals dedicated to changing lives.

• Perform analysis of medical payment rates and fee schedules as needed.
• Ensure fee schedules are loaded according to the provider contract, including analysis of implemented contracts.
• Responsible for researching and determining the proper fee schedule. This includes having one or more states assigned to this position.

All procedures that fall under that states fee schedule is required to be analyzed and interpreted.

• Responsible for the identification, correction, and root cause analysis of fee schedule load and reimbursement problems which includes partnership with various departments within NSM.
• Analytic, problem solving, technical skills and attention to detail are required.
• Candidates will be expected to identify areas of improvement within the scope of this function and work with Payer Relations leadership to document and implement change.
• Maintain accuracy and integrity of data on the company intranet.
• Communicate directly with payers via phone, email, or any other means necessary to gather necessary information.
• Must maintain regular and predictable attendance.
• Assume other duties and responsibilities as assigned.
• Individuals will be expected to maintain a professional work environment at all times and may be limited to a certain amount of personal items at work stations.

Work Environment :

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, printers, photocopiers, filing cabinets and fax machines .

Physical Demands :

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is regularly required to sit;

use hands repetitively to operate standard office equipment. The employee is frequently required to reach with hands and arms.

Required Education, Experience & Competencies :

Excel Knowledge

• Advanced level use and understanding of excel spreadsheets to include formulas, pivot tables & v-look up.
• Use excel to complete analysis such as fee schedule comparisons, building of new fee schedules for loading purposes, etc.

Organization

Highly organized detail oriented, critical thinking skills & the ability to prioritize work as needed.

Medical Vernacular

Understanding of commonly used terms such as modifiers, allowable, remittance advice, coordination of benefits, etc.

Education and formal training

High School Diploma or equivalency certificate. Additional training in Microsoft Office, Excel and Adobe Acrobat is a plus.

2 yr degree in business or healthcare also a plus.

Work experience

1 to 2 years related medical office experience required preferably DME experience. Experience with fee schedules, contracts, and / or billing is a requirement.

Knowledge, skills and abilities

• Knowledge of medical billing and insurance terminology highly desirable.
• Must be able to perform in a very fast paced and high-volume position.
• Sharp attention to detail and thorough in completing tasks.
• Strong data entry skills keyboarding / accuracy / speed.
• Working knowledge of Microsoft suite of products ( Outlook, Word and Excel) and Adobe Acrobat.
• Good oral and written communication skills. Strong reading comprehension skills.
• Typing and ten key experience a must.
• Ability to navigate on the internet and the company’s intranet.
• Have the ability to work in a team environment by being pleasant with others and displaying a good natured, cooperative attitude.

Be reliable, responsible, and dependable.

This job description in no way states or implies that these are the only duties to be performed by this employee. He / she will be required to follow any other instructions and to perform any other duties requested by his / her supervisor.

Last updated : 2024-05-13