Hotline: 678-408-1354

At PreferredOne, our name says it all! Everything we do is for one purpose – to make our valued members’ experience the best it can be. We achieve this by following five core values: compassion, service, integrity, agilityandtrust. These values are the beacon of who we are, what we stand for and what we do on behalf of our customers. For 30 years, we have been loyal to serving Minnesota and the upper Midwest.

Why consider PreferredOne for employment?

  • Welcoming, casual and team-oriented culture
  • Wellness amenities, including onsite fitness facility, massage therapist and personal trainer
  • Onsite cafeteria with fresh breakfast and lunch daily

Our most valuable assets are our employees; our employees are what makes us unique. Coupled with our high retention rates, our employees receive impeccable benefits at affordable premiums.

Purpose

Review, analyze and summarize data from multiple databases providing useful reports on a routine or ad-hoc basis for internal and external customers. Responsible for fee schedule development, creation and maintenance for all provider types. Responsible for report development, creation and maintenance and supporting regulatory reporting as needed.

Duties and Responsibilities

  • Design and develop reports from various databases to meet internal or external customer needs on a periodic or routine basis. Reports may require the integration of information from more than one database.
  • Design, develop and maintain operational reports including but not limited to, Medical Management, Quality Management and Wellness departmentsDevelop and analyze financial models to support and assist contract negotiations including identifying issues and concerns and making recommendations for improvements or changes in contractual arrangements
  • Perform for the purpose of creating, developing, and recommending fee schedules or payment methodologies that support PreferredoneOne reimbursement strategies and budget targets. Once created, maintain fee schedules for all provider types.
  • Interface with various departments to represent department or assist in resolving issues related to pricing, reimbursement, modeling, analysis, claims, system setup or other provider network issues.
  • Assist in the development of policies and procedures for department.
  • Develop, create and maintain department tools and documentation.
  • Use available reporting tools/programming languages to design reports and programs that will enhance the department’s functionality.
  • Performs other related duties as assigned.

Required Education, Experience and Skills**

  • 4 year college degree or equivalent combination of education and experience.
  • Basic knowledge of medical claims processing procedures and coding structures.
  • Experience with retrieval and analysis of data from large databases.
  • 1-3 years managed care or healthcare industry experience.
  • Programming experience including but not limited to SQL, Excel, Access, and Crystal.
  • Demonstrated understanding of knowledge of payment/reimbursement methodologies including but not limited to MS DRGs, APC, RBRVS, and knowledge of HCPCS, CPT, ICD-10, DRG, Revenue coding and claims submission requirements.
  • Familiarity with claims applications (Facets, Networx, WERP).
  • Demonstrated strong problem-solving, critical thinking, and customer service orientation.
  • High level of individual initiative; self-motivated and able to work independently as well as part of a team.
  • Well-organized and detail-oriented.
  • Excellent verbal and written communication skills.
  • Outstanding interpersonal skills, including conflict diffusion and resolution and follow-through.
  • Ability to deal effectively with a broad base of internal and external customers.
  • Project management skills.

Desirable Qualification

  • Excellent listening skills
  • Not afraid to ask relevant questions.

Physical Requirements

  • Must be able to operate all office equipment including computer, copier, printers, fax machine and phone.
  • Ability to sit at desk, use computer and phones for majority of the workday.

Job Type: Full-time

Share this job

At PreferredOne, our name says it all! Everything we do is for one purpose – to make our valued members’ experience the best it can be. We achieve this by following five core values: compassion, service, integrity, agilityandtrust. These values are the beacon of who we are, what we stand for and what we do on behalf of our customers. For 30 years, we have been loyal to serving Minnesota and the upper Midwest.

Why consider PreferredOne for employment?

  • Welcoming, casual and team-oriented culture
  • Wellness amenities, including onsite fitness facility, massage therapist and personal trainer
  • Onsite cafeteria with fresh breakfast and lunch daily

Our most valuable assets are our employees; our employees are what makes us unique. Coupled with our high retention rates, our employees receive impeccable benefits at affordable premiums.

Purpose

Review, analyze and summarize data from multiple databases providing useful reports on a routine or ad-hoc basis for internal and external customers. Responsible for fee schedule development, creation and maintenance for all provider types. Responsible for report development, creation and maintenance and supporting regulatory reporting as needed.

Duties and Responsibilities

  • Design and develop reports from various databases to meet internal or external customer needs on a periodic or routine basis. Reports may require the integration of information from more than one database.
  • Design, develop and maintain operational reports including but not limited to, Medical Management, Quality Management and Wellness departmentsDevelop and analyze financial models to support and assist contract negotiations including identifying issues and concerns and making recommendations for improvements or changes in contractual arrangements
  • Perform for the purpose of creating, developing, and recommending fee schedules or payment methodologies that support PreferredoneOne reimbursement strategies and budget targets. Once created, maintain fee schedules for all provider types.
  • Interface with various departments to represent department or assist in resolving issues related to pricing, reimbursement, modeling, analysis, claims, system setup or other provider network issues.
  • Assist in the development of policies and procedures for department.
  • Develop, create and maintain department tools and documentation.
  • Use available reporting tools/programming languages to design reports and programs that will enhance the department’s functionality.
  • Performs other related duties as assigned.

Required Education, Experience and Skills**

  • 4 year college degree or equivalent combination of education and experience.
  • Basic knowledge of medical claims processing procedures and coding structures.
  • Experience with retrieval and analysis of data from large databases.
  • 1-3 years managed care or healthcare industry experience.
  • Programming experience including but not limited to SQL, Excel, Access, and Crystal.
  • Demonstrated understanding of knowledge of payment/reimbursement methodologies including but not limited to MS DRGs, APC, RBRVS, and knowledge of HCPCS, CPT, ICD-10, DRG, Revenue coding and claims submission requirements.
  • Familiarity with claims applications (Facets, Networx, WERP).
  • Demonstrated strong problem-solving, critical thinking, and customer service orientation.
  • High level of individual initiative; self-motivated and able to work independently as well as part of a team.
  • Well-organized and detail-oriented.
  • Excellent verbal and written communication skills.
  • Outstanding interpersonal skills, including conflict diffusion and resolution and follow-through.
  • Ability to deal effectively with a broad base of internal and external customers.
  • Project management skills.

Desirable Qualification

  • Excellent listening skills
  • Not afraid to ask relevant questions.

Physical Requirements

  • Must be able to operate all office equipment including computer, copier, printers, fax machine and phone.
  • Ability to sit at desk, use computer and phones for majority of the workday.

Job Type: Full-time

Share this job

Contact Us

Eltas EnterPrises Inc.
3978 Windgrove Crossing
Suite 200A
Suwanee, Georgia
30024, USA
contact@eltasjobs.com

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