General Purpose
As a Fee Schedule Specialist, you’ll be the go-to expert for ensuring our systems and teams stay aligned with ever-evolving state regulations. You’ll own the research, interpretation, and maintenance of complex fee schedule requirements—playing a critical role in driving compliance and operational accuracy across the organization. From communicating regulatory updates with clarity to supporting system testing and partnering with tech teams to automate integrations, your work will directly impact the efficiency and reliability of our processes. You’re detail-oriented, proactive, and skilled at turning complex regulations into clear, actionable guidance. With strong knowledge of healthcare billing codes and reimbursement rules, you thrive in cross-functional teams and take pride in keeping systems accurate and compliant.
Duties & Responsibilities
- Proactively track and identify state regulatory updates using official sources and subscription tools; ensure timely internal communication and response.
- Collaborate with Bill Review leadership, maintaining deep knowledge of evolving state regulations and their implications for our business.
- Deliver clear, actionable guidance on fee schedules and compliance to cross-functional teams—including product, project, and business development—to ensure informed decision-making.
- Interpret complex fee schedule rules and update internal systems (Harmony & Melody) to ensure compliance is accurately reflected in system behavior and validations.
- Collaborate with technology teams and the Bill Review Manager to embed regulatory logic into our systems and ensure validation rules are current and correctly applied.
- Develop and lead training initiatives, creating materials and hosting sessions to educate teams on compliance updates. Provide digestible summaries for leadership when changes are minor.
- Stay current on CPT, HCPCS, and revenue codes, as well as reimbursement methodologies, to ensure alignment with state-specific billing requirements.
- Other duties as needed.
Qualifications
- Bachelor’s degree in a related field preferred, but not required.
- 3+ years of experience in workers’ compensation, healthcare reimbursement, or a related field.
- Strong background in regulatory documentation and the ability to communicate state regulation updates clearly to diverse teams.
- Familiarity with state-specific regulatory update cycles and subscription-based alert systems.
- Experience working with engineering and compliance teams to ensure proper system implementation of regulatory changes.
- Excellent written, verbal, and interpersonal communication skills.
- Strong organizational skills with the ability to manage complex tasks independently.
- High attention to detail and ability to meet deadlines in a fast-paced environment.
- Comfortable working with Microsoft Office tools, especially Excel, Word, and Outlook.
- Proactive, solution-oriented, and able to collaborate across departments with a team-first attitude.
