Job DetailsThe Director, Provider Reimbursement and Contract Analysis is responsible for developing reimbursement strategies and methodologies, network reimbursement / financial analyses, and related reimbursement operations. The position is responsible for oversight of all reimbursement functions for the HPP Pennsylvania provider network and future expansion markets.
Job Description- Responsible for establishing reimbursement methodologies, strategies, and payment analysis for all provider types.
- Responsible for the design and oversight of payment methodologies to providers representing more than $1B annually.
- Develop reimbursement strategies and systems based upon a technical understanding of industry standards and innovative payment models, including specialized knowledge of Pennsylvania Medicaid and CMS Medicare payment methodologies.
- Develop financial models to support network negotiations and payment system strategies, including relative rate benchmarking. Works with the contracting team to evaluate contract proposals.
- Develop and maintains analytical processes to ensure claims payment integrity, including consistency with provider contracts and HPP payment policies.
- Develop and maintains provider contract compensation exhibit templates, alternative reimbursement language library and ensures contracted reimbursement terms can be successfully operationalized and automated.
- Work closely with the Provider Contracting team to coordinate the "end-to-end" contracting process. This includes oversight of provider contract and fee schedule system configuration, related quality assurance procedures, and enforcing adherence to associated policies and procedures.
- Participate in the Medical Cost Action Plan program, including implementing initiatives to reduce medical costs trends and identify opportunities for medical cost reductions.
- Coach and lead team to continuously grow knowledge and analytical skills and improve operational performance.
- Recruit, develop, motivate and retain a high caliber of team members.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education:
- Bachelor's Degree in related field/equivalent; Masters' Degree preferred.
Experience:
- Minimum of 10 years' progressive experience in a managed care setting/role with a comprehensive understanding of provider reimbursement, provider contracts, financial modeling and advanced claims analytics.
#LI-HybridWork ShiftWorkday Day (United States of America)
Worker Sub TypeRegular
Employee EntityHealth Partners Plans, Inc.
Primary Location Address1101 Market, Philadelphia, Pennsylvania, United States of America
BenefitsJefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.
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