Provider Reimbursement Program Specialist

Job ID: CH-1018703 Description:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants.We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

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Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "my account" and click on "View your job submissions".

BASIC FUNCTION:

Located in Chicago, IL this position is responsible for the analysis, programming, reporting and modeling hospital performance measures using claims data. Extract claims data, construct models and write algorithms to simulate the financial impact of alternative reimbursement terms including value based provisions. Identify trends and variances in hospital outcomes and reimbursement ensuring contract compliance.

JOB REQUIREMENTS:

  • Bachelor Degree in Computer Science and 6 years programming experience using programming/reporting (SQL, Java, Crystal Reports, FOCUS, etc) and other programming languages (COBOL, JCL, Databases) OR 10 years experience.
  • Experience as an analyst/developer responsible for production activities for a designated system.
  • Experience utilizing leading-edge technology, i.e., DB2, SQL, SAS
  • Experience in coordinating efforts of internal departmental and third party vendors. Knowledge of the health care industry, insurance concepts, claims processing, and provider/membership systems.
  • Knowledge of financial reporting, balancing (controls), and accounting techniques. Knowledge of financial reporting and balancing techniques.
  • Experience in managing projects from beginning to end, obtaining desired results in specified time frames, business evaluation of needs, project implementation, project management, scheduling, and resource allocation.
  • Experience in providing technical and non-technical guidance to less experienced programmers.
  • Experience in debug complex programs without assistance.
  • Analytical skills.
  • Verbal and written communications skills.

PREFERRED REQUIREMENTS:

  • Advanced SQL and SAS programming experience.
  • Knowledge of Insurance concepts, hospital reimbursement principles (e.g., DRG based reimbursement, APCs, etc.) and managed care hospital contracts.

Position is located in Chicago, IL

Relocation assistance not available

Sponsorship not available

LI-POST

  • CA
  • CB*

Requirements: Expertise Network Management / Provider Relations Job Type Full-Time Regular Location IL - Chicago


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