This position will provide recommendations to management in the structuring and maintenance of reimbursement methodology for
institutional, professional and ancillary provider networks. This position will be involved in working with the Manager of Reimbursement and Business Analytics to evaluate and model alternative reimbursement methodologies and determining the impact that such methodologies would have on historical and future claimsutilization. The position would work with the Health Network Reimbursement team to ensure that any reimbursement methodologies that are being considered for implementation can be administered efficiently on company systems.
What you'll do:
- Work in conjunction with the Manager of Reimbursement and Business Analytics to develop criteria and evaluate rate proposals for
institutional, professional and ancillary providers to determine trend, medical cost and pricing impact within targets set by Network
- Coordinate the communication and implementation of new reimbursement contracts within defined time frames.
- Project manage the yearly provider reimbursement life cycle. Included, but not limited to building out the projected contract renewal calendars, tracking the contract negotiation process, and implementing signed provider agreements.
- Perform research projects as assigned that assist HNS management team in making strategic reimbursement methodology decisions.
- Develop and maintain front-end reimbursement validation and post payment reimbursement audit process.
- Develop, publish, and monitor reimbursement balanced scorecards to evaluate provider contract performance.
- Stay current on government and commercial reimbursement methodologies, trends, policies, and industry practices.
To be considered for this position, you must have:
- Bachelor’s Degree in Business, Health Care or related field
- Five (5)years’experience in modeling and administration of provider reimbursement methodologies (or comparableexperiencewith healthcare data).
- An equivalent combination of education and experience may be substituted to meet this requirement.
- The ability to meet or exceed the attendance and timeliness requirements of their departments.
- The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.