Claims, Audit and Recovery
Reimbursement Senior Analyst
Louisville , KY, United States

It’s Time For A Change…Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

This position is responsible for driving change management by use of statistical methods and data analysis with purpose of identifying financial and non-financial impacts to the plan.

Medical Coding Certification or equivalent experience with medical coding required.

Principal Accountabilities:

  • Works closely with cross-functional development teams to help establish and enforce data quality standards and documentation.
  • Translates CMS/DMS reimbursement policies into business requirements for implementation.
  • Writes and communicates effectively changes to claims system configuration.
  • Reviews and updates departmental policies and procedures.
  • Manipulates data into pivot tables, summaries, and use of VLOOKUP functions, etc.
  • Serves as an internal consultant and subject matter expert on projects and business initiatives that require knowledge of FACETS claims processing system.
  • Performs analysis of processes, procedures, and identify areas for improvement.
  • Develops tracking and reporting mechanisms to monitor activities.
  • Assists with coordinating data and reports to be submitted to the Department of Medicaid Services.
  • Investigates, develops and presents cost and benefit analysis with the purpose of identifying financial and non-financial impacts and potential process and system improvements.
  • Demonstrates technical and project management skills with the ability to coordinate and manage multiple concurrent projects.
  • Provides training and consulting on findings and measurements to others.
  • Ensures contracts can be operationally adjudicated and the reimbursement methodologies are compatible with FACETS capabilities.
  • Analyzes data from conceptualization through presentation and requires proficiency with analytical tools, knowledge of data analysis methodology, use of presentation software, and strong communication skills.
  • Perform other duties and projects as assigned.

Key Competencies:

  • Lives the values: Integrity, Community, Collaboration and Stewardship, as defined in the performance appraisal.
  • Ability to work independently and take ownership of responsibilities.
  • Ability to multi task and meet deadlines.
  • Detail-oriented and great organization skills.
  • Ability to interface with all levels of management and work in a team environment.
  • Strong verbal and written communication skills.
  • Possess understanding in the areas of application programming, database and system design.
  • Proficient experience using Outlook, Word, Excel and PowerPoint in a Windows operating system.
  • Demonstrated use of critical thinking and analytical skills to solve complex problems.
  • Experience summarizing data and creating executive summaries with analysis.

   The Experience You Need:

  • Associate degree or higher and/or three years equivalent work experience.
  • Minimum of 2-3 years claims, billing or auditing experience preferred.
  • 5-7 years Healthcare experience preferred.
  • 1- 2 years project management experience preferred.
  • Knowledge of Medicare/Medicaid reimbursement methodologies.
  • Advanced Microsoft Excel and/or Access knowledge.
  • Medical Coding Certification or equivalent experience with medical coding required.

    Evolent Health is an Equal Opportunity/Affirmative Action Employer

Job Alerts