Manager, Provider Reimbursement & Administration

HEALTH PARTNERS, a growing, progressive Managed Care Organization serving the Medicaid and Medicare population in Philadelphia and surrounding counties seeks a Manager of Provider Reimbursement & Administration  to join its Provider Affairs Team.  We offer excellent benefits, competitive salaries and a great 401(k) Plan.

 

GENERAL DESCRIPTION:  Manage, coordinate and implement a broad range of projects and programs in direct support of the Provider Affairs Division, as well as day-to-day management of Provider Network Administration.

 KEY REQUIREMENTS: Bachelors Degree in business, finance, economics or healthcare administration, or 5 years experience in managed care and/or indemnity insurance with a minimum of 3 years in a management position.  Database, fee schedule, and reimbursement experience required.  Working experience with mainframe systems as well as PC based applications such as Excel, Access, and Word.  Working knowledge of claims processing, customer or provider service preferred.  Working knowledge of and experience in developing and managing budgets preferred.  Experience in managing cross functional teams in claims and/or provider affairs areas preferred.  Excellent organizational, interpersonal, multitasking, time management and written and oral communication skills.  Ability to work independently and part of a team. Strong negotiation and conflict resolution skills required.  Process and project management ability. 

PRIMARY RESPONSIBILITIES:  Manage cross-functional employees to meet and exceed service requirements and functional objectives.  Recruit, develop, motivate and retain a high caliber of team members. Build and administer a business plan, control expenses, and increase profitability to meet established business goals. Maintain a positive work environment that supports self-direction; provide a structure to optimize experience, skill, knowledge and capability of the team. Reward team members based on contribution and performance.  Maintain and foster a collaborative relationship with internal and external customers.  Manage budget and control expenses while meeting operational, financial and service requirements.  Oversee the maintenance non-credentialed providers and reporting function for the provider network area.  Oversee provider fee schedules and develops and implements provider reimbursement programs, policies, and strategies.  Directs the implementation of medical policy to ensure the correct adjudication of claims in accordance with provider contracts.  Establish a quality assurance program, maintain provider networks and set up and maintain numerous fee schedules. Recommend reimbursement rates and strategies for new or revised fee schedules. Ensure all provider information is correct for claim processing, authorizations, correspondence, directories and reporting. Manage process for generating and producing provider directories. Perform other duties as assigned.