Provider Reimbursement Policy Manager – Patient Safety

Role Overview

• responsible for managing key components of the provider reimbursement strategy and policy
• Ensures accurate adjudication of claims
• translating various complex coding, business and billing rules and standards into effective and accurate reimbursement policies
• Serves as subject matter expert regarding reimbursement policies
• Leads policy development for specific plan(s) and/or the development and implementation of behavioral health reimbursement policy rules
• Works with the multiple business areas to ensure that accurate cost of care targets are incorporated into the company's financial plans
• Performs and/or directs complex research to ensure that projected changes meet corporate cost targets
• Prepares and presents cost of care data analysis to support the regions cost of care initiatives
• Develops and maintains the provider reimbursement policies that will lower the cost of care, improve service, and reduce administrative expenses
• Manages special projects and initiatives

Requirements

• Requires a BA/BS degree in a related field
• a minimum of 7 years reimbursement experience
• performing detailed financial modeling and economic analyses
• CPC
• Certified Professional Coder strongly preferred
• RN/Clinical background preferred
• Patient Safety Experience preferred
• Understanding of pricing methodologies
• working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG
• Strong research and analysis experience preferred
• Strong written and verbal communications

Benefits

• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution
• Paid Time Off
• wellness programs
• financial education resources