Senior Manager, Provider Reimbursements

HMSA•Honolulu, HI

2d•Hybrid

About The Position

This role oversees the management and staff responsible for the implementation and administration of Provider Reimbursement methodologies for various provider types. The position involves providing management reports and analysis for decision-making, contracting, and ensuring network access. It also includes participating in provider negotiations, administering operational activities for contract compliance, and serving as a department leader on large corporate projects. The role involves recruiting, training, and managing staff across the Finance department, fostering their growth and accountability. Additionally, it entails oversight of the department's compliance policies and procedures according to various regulatory guidelines, planning and coordinating projects, responding to ad-hoc data requests, and establishing productive working relationships with internal and external parties. The Senior Manager will also assist in budget monitoring and planning, coordinate audits, and perform other assigned duties.

Requirements

Bachelor's degree and six years related experience in financial reporting and/or data analysis, or equivalent combination of education and experience.
Two years of supervisory/management experience.
Effective written and verbal communication skills.
Demonstrate knowledge in project management, planning, and organization.

Responsibilities

Oversee management and staff responsible for implementation and administration of Provider Reimbursement methodologies, including Institutions, Professionals, and ancillary providers.
Provide management reports and analysis needed for decision making, physician and institutional contracting, and ensuring adequate provider network access.
Participate in provider negotiations to ensure that costs are within the anticipated budget.
Administer operational activities to ensure compliance with par provider contracts.
Serve as department leader on large, corporate-wide projects and programs that affect the organizations long term goals and objectives.
Partner with management to determine projects/programs desired outcomes as it relates to corporate strategies.
Recruit, train, and manage staff spanning across all areas of the entire Finance department.
Develop and foster personal growth, learning, and accountability of the staff.
Has oversight of the department's compliance policies, procedures, and internal controls in accordance with SSAE, CMS, MAR, SOC 2, BCBSA guidelines, and other regulatory requirements.
Plan, schedule, measure and coordinate projects and tasks for unit and other business areas.
Make decisions to control scope and resources, prepare documentation and ensure work flows are in accordance with our par contracts; through use of effective communication skills.
Acts as a Lead Representative, presenting HMSA's case externally to the Fee review committee.
Respond to ad-hoc data requests from management, executive staff, and external departments in relation to corporate goals and initiatives to HMSA's vision.
Coordinates Finance duties for Physician fee reviews for all lines of business.
Establish and foster productive working relationships with internal and external parties.
Effectively conducting meetings and discussions to achieve collaboration, trust, and consensus.
Achieving service commitments from core and support functional areas.
Prioritizing, tracking, and managing deliverables.
Assist in monitoring and planning for the department budget.
Coordination of all Internal and External audits and implementation of control points for fee loading internally and with partners.
Perform all other miscellaneous responsibilities and duties as assigned or directed.