Job Title:
Director of Payor Strategy and Reimbursement
Agency:

Department of Public Health

Job Requisition ID:

Shift:
Day (United States of America)
Compensation Details:
$85,508.41 - $113,824.07

Job Description:

Click HERE for Video

Job Summary:

The Director of Payor Strategy and Reimbursement leads the Georgia Department of Public Health's efforts to strengthen reimbursement for public health services from Medicaid, PeachCare for Kids, Medicare, commercial insurance carriers, and other third-party payors.

The Director works with DPH program offices, Georgia's 18 public health districts, the Georgia Department of Community Health, and other payor and government partners to identify reimbursable services, develop and recommend reimbursement methodologies, and address barriers to payment. This position evaluates program services, coding requirements, payor contracts, and operational workflows to help ensure DPH and public health districts receive appropriate reimbursement for covered services.

The Director also leads the development of processes and procedures for identifying patients within DPH programs who may qualify for Medicaid or other coverage and connecting those individuals with appropriate enrollment resources. The position monitors changes to Medicaid and other payor programs and works with DPH programs and public health districts to update operational procedures accordingly.

The Director serves as DPH's principal strategic advisor on payor policies and provides leadership to guide programmatic and policy decisions.

Primary Duties & Responsibilities:
• Serves as DPH's liaison with the Georgia Department of Community Health and develops effective working relationships with Medicaid managed care organizations, Medicare, commercial insurance carriers, and other third-party payors.
• Advises DPH leadership and public health districts on payor policies, reimbursement opportunities, coverage requirements, and changes affecting public health services.
• Identifies barriers that prevent or limit reimbursement and develops recommended solutions.

Reimbursement Strategy and Methodology Development:
• Leads assessments of DPH and public health programs to identify services that may be reimbursable by third-party payors.
• Develops and recommends reimbursement methodologies for DPH programs to maximize appropriate revenue.
• Develops standardized billing procedures, tools, resources, and best practices that can be implemented across DPH programs and public health districts.

Patient Coverage and Enrollment Processes:
• Leads the development of standardized processes for DPH programs to identify patients who may qualify for Medicaid, PeachCare for Kids, or other health coverage and directing them to appropriate enrollment resources.
• Works with public health districts to incorporate coverage screening and enrollment referrals into patient registration and service-delivery workflows.

Payor Policy Monitoring and Operational Implementation:
• Monitors policy changes that affect coverage or reimbursement and evaluate the operational and financial impact on DPH programs and public health districts.
• Develops recommendations for affected programs, including revisions to policies, procedures, billing rules, forms, training materials, contracts, and information systems.

Minimum Qualifications:

Bachelor's degree in health care services or related field from an accredited college or university and six (6) years of professional managerial or supervisory experience in health care services; or two (2) years of experience at the lower-level Sr Mgr., Health Care (HCM013) or position equivalent. Note: Some positions may require certification and/or licensure.

Preferred Qualifications:
• Strong understanding of Medicaid and other healthcare reimbursement systems, both public and private payor systems.
• Knowledge of revenue cycle, reimbursement methodologies and medical billing, including applicable billing and diagnosis codes.
• Familiarity with eligibility verification, coordination of benefits, claims submissions, appeals, and payment reconciliation.
• Strong project-management skills and demonstrated ability to coordinate initiatives involving several programs. Project Management Professional (PMP) or a comparable project-management credential is preferred. Demonstrated experience successfully leading complex healthcare reimbursement initiatives may substitute for certification.
• Strong written and verbal communication skills, including the ability to provide clear recommendations to executive leadership.
• Knowledge of DPH programs and the public health service-delivery system.

Additional Information:

The DPH Commissioner and agency leaders encourage all employees to engage in regular wellness activities and to make lifestyle choices that promote health and well-being.

The use of physical activity breaks during the workday is authorized to support this philosophy and help employees meet their wellness goals. A maximum of 30 minutes of physical activity may be allocated per workday, typically in the form of two 15-minute breaks or one 30-minute break.

Employment Information

State of Georgia employees are subject to the rules of the State Personnel Board regarding salary.

DPH accepts educational credentials recognized by the Council for Higher Education Accreditation (CHEA) and/or the US Department of Education (DOE) as valid. DPH will contact educational institutions to verify degrees, diplomas, licensures, and other relevant credentials.

The candidate selected for this position may be subject to pre-employment drug screening and a criminal background check.

Relocation assistance is not provided.

In the event of an identified emergency, you may be required, as a term and condition of DPH employment, to assist in meeting the emergency responsibilities of the department.

BENEFITS

Standard Benefits for Full-Time Salaried Employees
In addition to a competitive salary, we offer a generous benefits package that includes a flexible schedule, training opportunities, health insurance, employee retirement plan (ERS GSEPS), deferred compensation, 13 paid holidays, vacation and sick leave, paid parental leave, dental, vision, long-term care, and life insurance.

Standard Benefits for Part-Time Employees

Part-time employees are eligible to participate in the Georgia Defined Contribution Plan and receive paid parental leave.

Minimum Qualifications:
Bachelor's degree in health care services or related field from an accredited college or university and six (6) years of professional managerial or supervisory experience in health care services; or two (2) years of experience at the lower level Sr Mgr, Health Care (HCM013) or position equivalent.--Note: Some positions may require certification and/or licensure.