Healthcare Fee Schedule Analyst
Summary of Position
The Fee Schedule Analyst position requires an individual who is familiar with and understands the underpinnings of various fee schedules, including, but not limited to the Center for Medicare & Medicaid Services (CMS) Medicare fee schedule and state Workers’ Compensation fee schedules. This position will be responsible for researching and creating models to help determine reimbursement values based on specified criteria. Responsibilities include the design, development, updating and deployment of multiple state fee schedules.
The Fee Schedule Analyst will work with analytics, customer support, business development and the clinical team to update existing and develop new fee schedules and payment rates for State Workers’ Compensation programs. The individual will serve as a subject matter expert for each of the state based schedules and will be responsible for all associated statistical methodologies to create the reimbursement models.
The Fee Schedule Analyst will write programs to import current fee schedules, perform statistical analyses, including providing comparisons to older fee schedules, Medicare rates and other state fees schedules and to generate new fee schedules. In addition, the Fee Schedule Analyst will export the new fee schedules into a format which can be directly incorporated into regulations and state fee schedule rules and guidelines.
This position requires an individual with a deep understanding of healthcare claims data and Medicare fee schedules. This person will have strong analytic skills and will enjoy working in a fast-paced and challenging environment. When not working on fee schedules, this position may assist in the development of FAIR Health benchmark products and custom analytics.
- Research all required sources of documentation for assigned Worker’s Compensation States: This includes current data and fee schedule information
- Evaluate, analyze and implement CPT, HCPCS, CDT code and DRG additions/changes/deletions for integration into Fee Schedules
- Interpret each state-based fee schedule rule set and document the variations in the scenarios
- Perform data transformation, analysis and reporting of claim data, utilizing SAS and other programmatic tools.
- Carefully document methodologies and exceptions by service area.
- Collaborate with clients, customer service and data analytics teams to ensure all values are accurate and current.
- Assist Customer Support with client inquiries.
Knowledge and Skill Requirements
- Knowledge of CMS and third-party fee schedules
- Understanding of healthcare claims payment methodologies, and claims editing policies
- Familiarity with health plan claims adjudication systems and interdependent applications
- Strong experience and knowledge of SAS, SAS BASE, SAS SQL, SAS Macros, SAS tools
- Ability to multi-task
- Excellent written and verbal communication skills.
- Analytic, problem solving, technical skills and attention to detail are required
- Strong interpersonal skills, including the ability to work in a highly cross-functional, multi-location organization
- Comprehensive knowledge of MS Office Suite of Products including Excel and PowerPoint
- Proficient in payment guidelines/practices/regulations both in the commercial and government space
**Interested candidates should submit their resume to firstname.lastname@example.org. Please include “Healthcare Fee Schedules Data Analyst” and your last name in the subject line.
FAIR Health, Inc. is an equal opportunity employer and an e-verify participant.**