[Remote] Clinical Budgeting Specialist

Note: The job is a remote job and is open to candidates in USA. reputed company is an accountable specialty care management organization focused on improving the lives of people with reputed company injuries and diagnoses. The Clinical Budgeting Specialist is responsible for the accuracy of risk-based contract budgets and forecasts, collaborating with multiple teams to ensure high-quality service and 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

Skills

• 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
• 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 levels, 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
• 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

Benefits

• 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).
• 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.
• 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.
• 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.
• 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 Excellence at reputed company (reputed company) program.

Company Overview