Manager Contract Compliance and Payment Variance

Highmark Health

1d • $51 - $84

About The Position

GENERAL OVERVIEW: This job supports the Managed Care Department in contract negotiations, contract compliance, and reimbursement analysis. Collaborates with key stakeholders with regard to payor policies and revenue impact of payor expected reimbursement.

Requirements

• Minimum Bachelor's degree in Finance, Business, or Healthcare Administration, or relevant experience and/or education as determined by the company in lieu of bachelor's degree
• 5 years in Health Care: Provider or Insurance
• 5 years in Financial Analysis
• 3 years in Healthcare Reimbursement
• 1 year in Leadership or Management
• Strong critical thinking, problem-solving skills and attention to detail
• Substantial organizations skills including managing multiple priorities
• Reliable customer service and communication skills
• Continuously searches for process improvements to achieve accuracy and efficiencies
• Proficient excel capabilities
• Ability to analyze data, anticipate requests, and draw conclusions

Responsibilities

• Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority. (20%)
• Manages all aspects of Managed Care related reporting including underpayments, reimbursement analysis, modeling analysis for negotiations and contract performance, and pay for value. (40%)
• Provides direction and leadership to Managed Care staff. (15%)
• Manages maintenance of the contract management system. (10%)
• Administers negotiation of SCAs, payor credentialing, and vendor management. (10%)
• Collaborates with Revenue Cycle, Finance, and other departments to provide information on payor policies, contract interpretation, and reimbursement analysis requests. (5%)
• Other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees