Medical Reimbursement Analyst
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At Notable Systems, we convert unstructured paperwork into secure, actionable data using cutting-edge AI technology. Leveraging techniques like optical character recognition, machine learning, and large language models, our solutions empower Durable Medical Equipment companies to execute their revenue cycle processes faster and more accurately at a reduced cost. By improving efficiency and reducing errors for our customers, we help patients to get the equipment they need - such as wheelchairs, oxygen tanks, blood sugar monitors, and infusion pumps - faster and with fewer delays and frustrations. This enables patients experiencing mobility challenges, recovering from surgery, living with diabetes, and experiencing other chronic and episodic health conditions to get the tools they need to safely manage their conditions from home.
While we are currently focused on the DME/HME industry, we see potential applications of our solutions to broader problems within healthcare and beyond. Join us!
Position Summary:
We are seeking a detail-oriented and experienced Medical Reimbursement Analyst to join our team. Reporting to the VP, Client Success, you will play a crucial role in maintaining the accuracy of our proprietary payor criteria rule system by creating and updating payor rules for DME and HME products.
Job Duties:
- Identify and review government and payor coverage criteria policy associated with client’s needs and requests
- Analyze payor policy guidelines and break them down into comprehensive rule sets, capturing dependencies and nuances
- Interpret and document coverage criteria policy guidelines by HCPC, ICD10, and other written requirements
- Collaborate with customers to understand their specific requirements, exceptions and interpretations to apply to the policy
- Apply customer specific exceptions and interpretations to the rule sets
- Collaborate with a team of software coders to convert the documented rules into code-based rules
- Act as a liaison between the coder team, customers, and other stakeholders to clarify requirements and ensure accurate rule implementation
- Perform extensive testing of the implemented rules to ensure adherence to payor policies and accurate medical necessity determination
- Prepare test files including redacting, merging and splitting PDFs, TIFs, and CSV files as needed
- Create testing plans per product category to ensure comprehensive testing and rule set accuracy
- Stay up-to-date with healthcare policies, compliance, industry trends, and best practices related to DME and HME products
- Monitor system output and coverage criteria policy rule changes that may impact results
- Perform ongoing quality assurance audits of rule sets that have been deployed
Required Qualifications:
- Identify and review government and payor coverage criteria policy associated with client’s needs and requests
- Analyze payor policy guidelines and break them down into comprehensive rule sets, capturing dependencies and nuances
- Interpret and document coverage criteria policy guidelines by HCPC, ICD10, and other written requirements
- Collaborate with customers to understand their specific requirements, exceptions and interpretations to apply to the policy
- Apply customer specific exceptions and interpretations to the rule sets
- Collaborate with a team of software coders to convert the documented rules into code-based rules
- Act as a liaison between the coder team, customers, and other stakeholders to clarify requirements and ensure accurate rule implementation
- Perform extensive testing of the implemented rules to ensure adherence to payor policies and accurate medical necessity determination
- Prepare test files including redacting, merging and splitting PDFs, TIFs, and CSV files as needed
- Create testing plans per product category to ensure comprehensive testing and rule set accuracy
- Stay up-to-date with healthcare policies, compliance, industry trends, and best practices related to DME and HME products
- Monitor system output and coverage criteria policy rule changes that may impact results
- Perform ongoing quality assurance audits of rule sets that have been deployed
Preferred:
- Experience in billing or quality assurance for oxygen, ventilators, wheelchair, CPAP, compression, wound care, diabetic supplies, glucose and/or ostomy, strongly preferred
- Experience redacting, merging and splitting documents
What We Offer:
- Health benefits as well as vision and dental insurance
Work from Home Requirements
- Reliable Internet: Minimum download speed of 50 mbps and upload speed of 10 mbps. You can test your internet speed at this link: https://www.speedtest.net
- Smartphone: Must have a smartphone, as we use multi-factor authentication for logging in to our system, so you will need to download an app to your phone.
- Equipment: Company laptop and optional external monitor will be provided.
- Privacy: Must have a private place to work in order to protect the confidentiality of the patient data we access.
