Director, Provider Reimbursement and Contract Analysis- JHP

Jefferson Health Plans • Philadelphia, PA

9d • Hybrid

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.

Requirements

• Bachelor’s Degree in related field/equivalent; Masters’ Degree preferred.
• 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.

Nice To Haves

• Masters’ Degree preferred.

Responsibilities

• 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.

Benefits

• medical (including prescription)
• supplemental insurance
• dental
• vision
• life and AD&D insurance
• short- and long-term disability
• flexible spending accounts
• retirement plans
• tuition assistance
• voluntary benefits
• tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.

What This Job Offers

• Job Type: Full-time
• Career Level: Director