Provider Payment Strategy Manager – Defined Term

Role Overview

• 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

Tech Stack

• SQL

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