Director, Provider Reimbursement and Contract Analysis- JHP

Jefferson Health Plans • Philadelphia, PA

110d

About The Position

The 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.

Responsibilities

• Establish reimbursement methodologies, strategies, and payment analysis for all provider types.
• Design and oversee 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.
• Work with the contracting team to evaluate contract proposals.
• Develop and maintain analytical processes to ensure claims payment integrity, including consistency with provider contracts and HPP payment policies.
• Develop and maintain provider contract compensation exhibit templates, alternative reimbursement language library and ensure contracted reimbursement terms can be successfully operationalized and automated.
• Work closely with the Provider Contracting team to coordinate the 'end-to-end' contracting process.
• 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.

Benefits

• 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.
• 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, have access to medical (including prescription) insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 501-1,000 employees