Job Description
Job Description
Interpret medical rules, regulations, fee schedules, and edits that payers post. Sources include (but may not be limited to Centers for Medicare Services CMS, State Health & Human Services Medicaid plans, Governmental payer Tricare, and all national commercial insurance plan payers that pay). You will report to Client Implementation Senior Manager.
Understand and manipulate payer data to build federal, state, and commercial coding and financial tables that support Experian Health product logic.Monitor and maintain the tables, due to unpredictable payer updates. Navigate complex and evolving regulatory scenarios.Analyze and maintain Medicaid master fee schedules.Think through situations independently and in collaboration with others.Maximize the efficiency and use of our product solutions in day-to-day operations by properly maintaining payer specific edits.Leverage internal loading systems to rou...