Manager Reimbursement Operations

Highmark Health•Washington, DC

1d•Onsite

About The Position

JOB SUMMARY This job plans, develops, and maintains operational processes and reporting related to group/provider facility and professional reimbursement configurations and other operational processes. Acts as the primary liaison between provider contracting, provider reimbursement, and claims experience. Collaborates with the pricing team to troubleshoot reimbursement issues and works with the Reimbursement Policy and Compliance team team to develop and maintain effective reimbursement quality programs and reporting. ESSENTIAL 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. Executes all reimbursement components of group/provider contracts and responsible for all associated status and issue reporting; serves as primary process input for provider contract execution for reimbursement. Plans, develops, and maintains operational systems, processes, and reporting related to group/provider facility and professional reimbursement configurations. Commits to ongoing process optimization and documentation of all applicable policies, procedures, and desk-level procedures. Serves as the primary enterprise liaison for provider reimbursement, including specially negotiated professional rates. Working with the pricing team, documents, troubleshoots, resolves, and reports all reimbursement issues and problems. Assists with the development and management of reimbursement compliance and quality programs. Develops and maintains all reporting, operational dashboards, and other reports associated with primary areas of responsibility. Other duties and special projects as assigned or requested.

Requirements

Bachelor's Degree in Healthcare Management or Business
6 years of related and progressive experience in lieu of Bachelor's degree
5 years in the Healthcare Industry
5 years with Reimbursement Operations
3 years in a Management or Leadership Role
Knowledge of provider business and systems
Ability to quickly identify and provide recommendations on issues and process improvements
Strong organizational and time management skills with the ability to multitask and reprioritize
Experience in team building, facilitation, negotiation and conflict resolution.

Nice To Haves

Master's Degree in Healthcare Management or Business
5 years in a Management or Leadership Role
3 years with Process Development and Optimization
3 years in Policy & Procedure Development and Enforcement
Certified coder
Lean Six Sigma Certification

Responsibilities

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.
Executes all reimbursement components of group/provider contracts and responsible for all associated status and issue reporting; serves as primary process input for provider contract execution for reimbursement.
Plans, develops, and maintains operational systems, processes, and reporting related to group/provider facility and professional reimbursement configurations.
Commits to ongoing process optimization and documentation of all applicable policies, procedures, and desk-level procedures.
Serves as the primary enterprise liaison for provider reimbursement, including specially negotiated professional rates.
Working with the pricing team, documents, troubleshoots, resolves, and reports all reimbursement issues and problems.
Assists with the development and management of reimbursement compliance and quality programs.
Develops and maintains all reporting, operational dashboards, and other reports associated with primary areas of responsibility.
Other duties and special projects as assigned or requested.