Provider Reimbursement Manager

This is a fully remote position, open to applicants in Ohio, +2 more states.

📋 Description

• Oversee the development of fee schedules for designated plans and/or create and implement clinical editing guidelines.

• Collaborate with Health Service Area, actuarial, decision support, and underwriting teams to integrate precise cost-of-care targets into product pricing and financial strategies.

• Conduct and/or lead intricate fee modeling tasks to ensure anticipated unit reimbursement adjustments align with corporate cost objectives.

• Offer analytical assistance during hospital and physician negotiations.

• Compile and present cost-of-care data analyses that support regional cost-of-care initiatives.

• Formulate and sustain provider reimbursement strategies aimed at reducing care costs, enhancing service quality, and minimizing administrative expenditures.

• Oversee special projects and initiatives.

• Communicate concepts to external stakeholders and act as a subject matter expert on cost of care.

⛳️ Requirements

• BA/BS degree in a relevant field and a minimum of 7 years of experience in reimbursement, including comprehensive financial modeling and economic analyses; or an equivalent combination of education and experience.

• CPC or CIC certification is required for consideration.

• Experience with WGS and/or GBD Facets is preferred.

• Strongly preferred experience in post-pay reviews, validation, and recovery processes within the healthcare sector.

• Strongly preferred experience in managing multiple projects to completion.

• Claim processing and adjustment experience are strongly preferred.

• Comfortable presenting ideas to external stakeholders.

• Possess subject matter expertise in cost of care.

• Ability to work general business hours, Monday through Friday.

• Candidates must live within a reasonable commuting distance of an eligible office unless an exception is granted.

• Preference will be given to candidates in the Eastern or Central time zones.

🏝️ Benefits

• Merit increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• Short-term disability benefits.

• Long-term disability benefits.

• 401(k) plan with company match.

• Stock purchase plan.

• Life insurance.

• Wellness programs.

• Financial education resources.

• Flexible virtual work arrangement.

• Required in-person training sessions to support onboarding and skill development.