Manages the advancement of provider reimbursement methodologies to align with organizational strategies and objectives, including value-based payment, and advises executive leadership regarding the feasibility of various strategies and methodologies
Utilizes a variety of methods and models to evaluate the feasibility of reimbursement methodologies
Provides management oversight and guidance related to the provider reimbursement function, acts as a subject matter expert, and provides guidance on departmental operations
Manages, supervises, mentors and trains assigned staff

Requirements

Bachelor’s degree in Finance, Economics, Accounting, Health Care or a related field
A minimum of eight years of experience performing provider reimbursement activities and/or provider payment strategy activities, including a minimum of three years of experience in a managed care environment, and a minimum of three years of management, supervisory, or lead experience; (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying.
Knowledge of: Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers
Knowledge of: Provider contracting, including language, reimbursement methods, and rates
Knowledge of: Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical and provider data
Knowledge of: Data modeling techniques and business analytical and data mining tools, including SQL, and data visualization tools
Knowledge of: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), ICD 9/10 and CPT codes, and industry standard groupers, such as ETGs, DRGs, and DCGs
Knowledge of: Managed care concepts, contracting, policies, and procedures
Ability to: Develop work plans and workflows and organize and prioritize provider reimbursement activities
Ability to: Train, mentor, supervise, and evaluate the work of staff, promote an atmosphere of teamwork and cooperation, and motivate staff to achieve goals and objectives
Ability to: Apply analytical and pricing expertise to the evaluation, negotiation, implementation, and maintenance of managed care contracts
Ability to: Perform technical and non-technical troubleshooting and diagnose and resolve complex problems, including problems that may have multiple variables and may not have obvious solutions
Ability to: Develop data-driven and outcome-based initiatives to improve business decision making and improve business processes

Benefits

Medical, Dental and Vision Plans
Ample Paid Time Off
12 Paid Holidays per year
401(a) Retirement Plan
457 Deferred Compensation Plan
Robust Health and Wellness Program
Onsite EV Charging Stations

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

provider reimbursement methodologiesvalue-based paymentdata modeling techniquesbusiness analytical toolsdata mining toolsSQLdata visualization toolsCurrent Procedural Terminology (CPT)Healthcare Common Procedure Coding System (HCPCS)ICD 9/10 codes

Soft Skills

management oversightmentoringtrainingteamworkcooperationanalytical expertiseproblem-solvingorganizational skillsprioritizationcommunication