Healthcare Services Specialist

Job Summary

A company is looking for a Healthcare Services Segment Specialist (RAC).

Key Responsibilities

• Lead reviews and updates of existing concepts based on client or regulatory changes
• Conduct research and document impacts for new concept development while ensuring training material updates
• Monitor and provide statistical analysis for audit concepts, ensuring compliance and timely application of regulatory changes

Required Qualifications

• Minimum 8+ years of experience in healthcare claim type subject matter specialty
• Bachelor's degree in a related field or equivalent experience
• Registered Nurse or Certified Coder with nationally recognized credentials required
• Broad knowledge of medical claims billing/payment systems and payer reimbursement policies
• Progressive healthcare data analysis experience, including gathering and documenting requirements