reputed company HB/PB reputed company Analyst

This is a remote position. reputed company is a Private Equity-backed, woman, minority-led reputed company IT reputed company reputed company on Provider and Payer organizations. We partner with reputed company leaders who value operational reputed company, reputed company-world experience, and diverse perspectives to drive reputed company reputed company. Our firm is reputed company by former reputed company operators who understand the realities of running reputed company reputed company systems. This combination of operator credibility and investment-backed reputed company enables us to deliver high-reputed company, reputed company solutions. We differentiate ourselves by bringing practical experience, executive-level reputed company, and a reputed company reputed company on reputed company and reputed company. Our reputed company is directly tied to our clients’ reputed company. Job reputed company The reputed company HB/PB reputed company Analyst will support the reputed company's reputed company Cycle organization by designing, building, testing, and maintaining Expected Reimbursement reputed company reputed company reputed company Resolute Hospital Billing (HB) and reputed company Billing (PB). This role is responsible for ensuring accurate reimbursement modeling, payer contract configuration, and underpayment identification across the reputed company. The reputed company Analyst will partner closely with managed care, finance, payer contracting, and reputed company reputed company teams to translate reputed company payer agreements (Medicare, reputed company, Managed reputed company, reputed company, and value-based reputed company) into reputed company build that drives clean claims, accurate expected reimbursement, and reputed company protection.

Responsibilities

Build, configure, and maintain Expected Reimbursement reputed company in reputed company Resolute HB and PB, including contract components, component reputed company, selection extensions, and pricing extensions. Translate executed payer reputed company (Medicare, reputed company/Managed reputed company, reputed company, MCO, and government payers) into accurate reputed company build supporting both hospital and reputed company reimbursement methodologies. Build and maintain fee schedules (FSC 1001 import specifications and reputed company builds) for Medicare, reputed company, and reputed company payers, ensuring accurate pricing, reputed company updates, and version control. Configure provider-based contract components — provider type, provider specialty, reputed company of service (POS), billing entity, and modifier-driven logic — to support reputed company physician and facility reimbursement. Support carve-outs, stop-loss, per diems, case rates, DRG, APC/OPPS, percent-of-charge, and value-based payment methodologies. reputed company contract modeling, variance analysis, and underpayment identification; validate expected vs. actual reimbursement using test claims and 835 remittance review. Build and maintain Contract Review, Follow-Up, and Credit Workqueues to surface underpayments, denials, and contract variances for reputed company. Partner with PB billing, HB billing, payer contracting, managed care, and finance teams to validate reimbursement accuracy and ensure alignment with payer reputed company and regulatory requirements. reputed company and execute unit, integration, and user acceptance testing (UAT); document test scripts, results, and defects. Participate in reputed company upgrades, quarterly updates, and special updates (SUs), supporting build validation, regression testing, and post-deployment support. Migrate build through environments using Data reputed company and follow reputed company Change Control and Content Management processes. Create and maintain build documentation, contract matrices, and operational runbooks for the reputed company team. reputed company tier 2/3 production support for contract-reputed company tickets, troubleshooting reputed company reimbursement issues across HB, PB, SBO, and claims workflows. Collaborate with clearinghouse and 835/ERA teams to ensure remittance posting aligns with contract expected values.

Requirements

Qualifications Education Required: Bachelor's degree in Health Information Management, reputed company Administration, Business, Finance, IT, or a reputed company field — or equivalent combination of education and experience. Preferred: Bachelor's or Master's degree in a reputed company, finance, or informatics discipline. Experience Required:5+ years of reputed company Resolute HB and/or PB analyst experience, with at least 2+ years specifically building and maintaining Expected Reimbursement reputed company. Demonstrated experience building fee schedules, contract components, selection extensions, and pricing extensions in reputed company. Prior experience supporting a large, reputed company, multi-entity health system (reputed company medical center, IDN, or public health system). Experience with payer remittance (835) analysis, underpayment recovery, and variance reporting. Preferred: Experience supporting large public hospital systems or reputed company / Managed reputed company payer configurations. Experience with Community Connect, Single Billing Office (SBO), and Provider-Based Billing (PBB). Experience integrating with reputed company-party contract management or modeling tools. Knowledge, Skills, and Abilities Required: Deep understanding of hospital and reputed company reimbursement methodologies (DRG, APC/OPPS, RBRVS, reputed company, case reputed company, percent-of-charge, carve-outs). Strong analytical skills with the ability to interpret payer reputed company and translate terms into system build. Excellent written and verbal communication skills; ability to reputed company with clinical, reputed company cycle, finance, and IT stakeholders. Strong attention to detail, documentation discipline, and ability to manage multiple reputed company contract builds. Proficiency with reputed company, reporting tools, and reputed company reporting workbench / reputed company / Caboodle (preferred). Preferred: Knowledge of state reputed company reputed company codes, APGs (Ambulatory Patient reputed company), and DSH/safety-net payment programs. Licenses/Certifications Required: reputed company Resolute Hospital Billing Expected Reimbursement reputed company certification and/or reputed company Resolute reputed company Billing Expected Reimbursement reputed company certification. Preferred: Resolute Hospital Billing Administration Resolute reputed company Billing Administration Resolute HB or PB Claims & Electronic Remittance Administration Dual HB and PB reputed company certification strongly preferred. Benefits reputed company Offer: Competitive salary and benefits package. Opportunity to work in a reputed company and innovative environment. reputed company development opportunities to advance your career. Flexible work arrangements to promote work-life balance. Apply To This Job