Value-Based Reimbursement Specialist

We are seeking a highly skilled and analytical Value-Based Reimbursement Specialist to join our team. This remote position is crucial for our organization's financial health, as you will be responsible for navigating the complexities of value-based care models. You will work to ensure accurate and timely reimbursement by managing claims, analyzing performance metrics, and collaborating with clinical and administrative teams to optimize revenue streams under these evolving payment structures.

Key Responsibilities

• Claims Management:
  • Process and submit claims to payers, ensuring accuracy and compliance with value-based contract terms.
  • Investigate and resolve claim denials and rejections, submitting appeals as necessary.
  • Monitor payment trends and reimbursement rates to identify and address any discrepancies.
• Data Analysis & Reporting:
  • Analyze clinical and financial data to identify opportunities for improving performance under value-based agreements.
  • Generate reports on key performance indicators (KPIs) related to reimbursement, quality measures, and patient outcomes.
  • Provide insights and recommendations to leadership and clinical teams to optimize revenue and quality.
• Compliance & Collaboration:
  • Stay up-to-date with industry regulations, coding changes (e.g., CPT, ICD-10), and payer policies related to value-based care.
  • Work closely with clinical staff, billing specialists, and care coordinators to ensure all documentation supports accurate reimbursement.
  • Act as a subject matter expert on value-based reimbursement for internal teams.

Qualifications & Skills

• Proven experience in healthcare billing, claims management, or reimbursement, specifically with value-based care models.
• Strong understanding of medical coding (CPT, ICD-10) and billing regulations.
• Exceptional analytical and data-interpretation skills.
• Excellent written and verbal communication abilities.
• Proficiency with healthcare information systems (HIS), electronic health records (EHR), and claims management software.
• Detail-oriented, organized, and capable of working independently in a remote environment.
• Bachelor's degree in Healthcare Administration, Finance, or a related field is preferred. A professional certification (e.g., CPC, RHIA) is a significant plus.

Benefits

• Competitive salary and performance-based incentives.
• Flexible work-from-home schedule.
• Opportunity to play a key role in the future of healthcare reimbursement.
• Collaborative and supportive team environment.
• Comprehensive benefits package.