Position Purpose: Develop and recommend provider reimbursement standards, policies, and guidelines that align with industry standards and state requirements. Serve as the key liaison between health plan network management, finance and contract implementation and configuration for reimbursement processes.
Research and analyze provider reimbursement methodologies and regulatory medical coding requirements to ensure alignment with state requirements.
Develop and maintain fee schedules as required by the state.
In collaboration with Finance, conduct impact analysis related to fee schedules or payment policy changes.
Serve as primary contact to the state for all provider reimbursement methodology issues.
Identify technological solutions to implement alternative payment solutions to improve cost and contract performance.
Develop standardized reimbursement payment solutions to improve, manage and predict unit cost performance
Oversee entire project life cycle, including deliverables, resource allocations, and implementation.
Develop improvement processes and methods used to implement new provider reimbursement for the business unit.
Education/Experience: Bachelor’s degree in Business Administration, Healthcare Administration, or related field or equivalent experience. 5+ years of provider reimbursement and analysis experience. Experience with Medicare and Medicaid reimbursement methodology. Managed care experience and provider billing experience preferred.