Healthcare Provider Contract and Pricing Manager

Performant • San Angelo, TX

3d • $90,000 - $110,000 • Remote

About The Position

The Manager, Healthcare Provider Contract and Pricing has responsibility for managing staff and creating an infrastructure to support Performant’s claims repricing and contract audits ensuring the needs of the business are met for successful daily operations of healthcare audit and recovery.

Requirements

• Excellent verbal and written communication and interpersonal skills; ability to effectively communicate at all levels within the organization both internal and external.
• Strong project and operations management skills; inventory management, resource planning, developing, and leveraging reports; developing policies and procedures.
• Leverages strong analytical, critical thinking and problem-solving skills; Skill in analyzing information, identifying trends, and presenting solutions.
• Demonstrated ability to apply excellent judgement and decision-making skills.
• Demonstrated success building and lead high performing teams.
• Adaptable and thrives in a fast-paced dynamic environment with changing priorities.
• Possess broad and comprehensive understanding of applicable healthcare concepts, standards, tools, policies, and regulations relevant for medical claim repricing: Knowledge in ICD-10-CM/PCS, CPT-4, and HCPCS coding;
• Experience in interpreting provider contracts payment methodologies, preferred
• Knowledge of the national coding standards, particularly payment rules
• Knowledge of commercial claims processing systems
• Knowledge of Medicare/Medicaid programs, particularly payment rules
• Experience analyzing and manipulating health care data leveraging strong data manipulation skills. using database and spreadsheet applications.
• Strong computer skills; intermediate level experience with MS Office products including Outlook, Word, PowerPoint, intermediate to advanced Microsoft Excel, and the ability to quickly develop expertise in new systems and applications.
• Use of logical and critical thinking skills and exceptional problem-solving skills to identify solutions to complex scenarios.
• BA/BS in relevant field (e.g., Finance, Accounting, Healthcare Administration) or equivalent combination of relevant education and experience.
• 7+ years of relevant experience in healthcare provider reimbursement and/or health insurance payor experience in medical billing, claims auditing, claims analysis and/or actuarial analysis.
• Minimum of 3 years in supervisory/management that includes oversite for remote staff.

Nice To Haves

• Experience with diagnostic grouper tools such as MS DRG, APC, APR-DRG, EAPG, preferred

Responsibilities

• Oversee team functions including, but not limited to: Interpretation (and documentation of) provider contract payment information for use by the complex and automated teams
• Development of algorithms to identify inappropriate payments
• QA of fee schedule loads - Analysis of data results to ensure accuracy of contract interpretation and system loads
• Creation and processing of system files, and needed workflows using available tools, specific layouts, conditions, and instructions to create overpayment files
• Responds to internal and external questions regarding data results and pricing calculations
• Participate in the development or analysis of new/changing concepts and related data
• Concept research and application of appropriate Medicare, Medicaid and other regulatory policy and rules
• Conducting sample tests to prove and quantify the value of concepts
• Hires, trains, and develops staff; proactively manages team performance against objectives and deliverables to ensure high quality output meets business needs, and: resolves conflict in a tactful and effective manner.
• Develops and ensures training and support to new team members as well as all team members for any new or changing workflows or requirements
• Develop and maintain infrastructure tools and documentation as well as contribute to the development and/or improvement based upon changing requirements and/or new client requirements/contracts.
• Drives research, analysis and resolution of complex questions, issues, and needs that arise.
• Drives continuous improvement efforts and develops/delivers tools and training to increase knowledge, efficiency, and consistency of department output.
• Applies strong communication and interpersonal skills to develop professional relationships and collaborates effectively with internal department leaders/staff, as well as clients and other external stakeholders and service providers.
• Maintains current knowledge of and compliance with company policies, processes and procedures, Medicare/Medicaid rules, regulations, policies and procedures, contract requirements, and HIPAA certification; and ensures team members do the same.
• Keeps abreast of medical practice, changes in technology, and regulatory concepts, or changes in reimbursement that may affect the Client contracts.
• Completion of Teleworker Agreement upon hire, and adherence to the Agreement (and related policies and procedures) including, but not limited to: able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with HIPAA, safety & ergonomics, confidentiality, and dedicated work focus without distractions during work hours.
• Other Duties as assigned

Benefits

• Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually.
• For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 1,001-5,000 employees