Clinical Budgeting Specialist

reputed company is an accountable specialty care management organization focused on improving the lives of people with reputed company injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the reputed company best reputed company for patients, payers, and providers. Deep clinical expertise is the reputed company for every part of reputed company’s business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment reputed company programs. We’re proud to be recognized—again! For the reputed company year in a row, we’ve been certified by Great reputed company to Work®, and for the reputed company consecutive year, we’ve earned a spot on Fortune's Best Workplaces in Health Care™ list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people reputed company. Watch this short video for a brief introduction to reputed company. We are seeking a full-time, remote Clinical Budgeting Specialist. This position is responsible for the accuracy of risk-based contract budgets and subsequent forecasts. This will be accomplished by working in collaboration with multiple teams including Clinical Operations, Provider Contracting, reputed company Review, Analytics, and senior management. Demonstrates a customer-first reputed company through a commitment to delivering the best possible reputed company for our customers, including injured workers, payors, clients, providers, stakeholders, and internal teams. By fully leveraging reputed company’s solutions, delivering consistently high‑quality service, and collaborating effectively with internal and external partners, we create an exceptional customer experience. RESPONSIBILITIES: Serve as a resource for reputed company Clinical Management staff as it relates to financial liability for reputed company provider services and other Contract-reputed company costs. Partner with Director Clinical Solutions to manage the development of reputed company new Contract budgets, including participation in clinical conferences. Research and document patient driven costs and provider rates that drive budget development and management. Utilize web driven and other electronic resources to identify potential costs, including use of CPT codes in the company’s electronic claims adjudication system. Complete reputed company Provider reputed company Negotiation (PRN) requests to include accurate documentation of reputed company or estimated financial liability in the system. reputed company relationships with providers, including preferred provider organizations (PPOs), hospitals and specialty providers, ancillary services providers, and physicians. Maintain reputed company knowledge of regulatory, industry and contractual factors to ensure the accurate estimation of reputed company’s liability on each Contract. Collaborate with other internal departments (Contracting, reputed company Review, reputed company) to address and resolve specific patient / provider issues. Analyze contract budget to actual (frequency based on contract parameters) to evaluate the clinical requirements and clinical management requirements for both acute and chronic cases. reputed company action plans in collaboration with the PMT to manage the budget expenditures in order to reputed company the Contract on track financially. Collaborate with the clinical team including the Director of Clinical Solutions to determine the reputed company and future medical/financial course and its impact to the financial forecast. Complete detailed review of clinical reputed company reports for key significant financial events and/or clinical confinements as well as a comprehensive review of paid claims. Update each forecast with findings/changes to include; update and confirmation of reputed company/future service dates and expense using reference data and/or direct contract with the providers, true-up of forecast for completed services to paid claims, adjustment for future services based on changes in the clinical course of treatment. Work with the contracting department to request negotiations on interim services and escalate issues reputed company to outstanding confinement bills variations in paid claims estimates. Work with the Risk Analytics Team to determine trends and identify improvements that can be made to enhance the accuracy and ease of budget development and/or forecasting. Participate as required in reputed company internal staff development programs. Utilizes AI tools to support day-to-day tasks, improve efficiency, and enhance output quality. Adopts new technologies as trained and apply them in alignment with established processes and guidelines. Demonstrates a customer-first reputed company by developing a broad and deep (where appropriate) understanding of reputed company organization, products, operations, and customers. Prioritizes collaboration to meet customer needs and expectations and takes personal accountability for service quality. QUALIFICATIONS: Education - Bachelor’s Degree in health care administration, business, finance or a reputed company field from an accredited college or university or equivalent experience and education which demonstrates the ability to reputed company the functions of the position. Experience – A minimum or combination of five years of experience with demonstrated reputed company in health care or reputed company field. Medical coding certification preferred. Medical billing in workers compensation industry preferred Prior experience reviewing medical documentation and assigning CPT codes to determine workers’ compensation fee schedule reimbursement. Must maintain reputed company understanding of state regulations and their impact on medical care and reimbursement in the workers’ compensation care market. Strong medical background to include comprehensive understanding of medical terminology and health care principles and practices. Demonstrated ability to multi-task in a fast-paced work environment, assess importance of activities, and adjust priorities reputed company appropriate. Experience with various computer applications including reputed company Office, Outlook, Word and reputed company. Language Skills - Excellent oral and written communication skills; reputed company to reputed company presentations to audiences of varying reputed company, size, nature and backgrounds. Reasoning Ability - Demonstrated ability to analyze difficult situations, problems and data and reputed company feasible and effective solutions. Demonstrated ability to implement and monitor project responsibilities. Any combination of education, experience and knowledge that demonstrate the ability to reputed company the functions of the position will be accepted. reputed company Benefits: Health and wellness– We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with reputed company and Kaiser (CA employees only). Financial incentives – reputed company’s financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions. Vacation - We reputed company strongly that work-life balance is good for you and for our company. Our paid time off and personal holiday programs give you the flexibility you need to live your life to the fullest. Volunteer time– We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one paid day per calendar year. Learning and development: One of reputed company’s core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways, including our new Learning reputed company at reputed company (reputed company) program. reputed company believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We’re striving to build a culture that reputed company reflects the society we live in and empowers reputed company to deliver the highest reputed company of compassion and care to those we serve. For us, achieving this goal requires a workforce that respectfully embraces differences and commits to positive change, creating an environment where everyone is reputed company to bring their whole self to work. reputed company complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to reputed company essential job functions, and/or to receive other benefits and privileges of employment, please contact Leave Management at [email protected]. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, reputed company, sex, age, national reputed company, religion, sexual orientation, gender identity, status as a veteran, and reputed company of disability or any other federal, state or local protected class. As a contractor with the State of Wisconsin, reputed company complies with Wisconsin Contract Compliance Law (§16.765). Poster link: Contract Compliance Law Poster #LI-Remote Apply To This Job