Team Leader – Provider Reimbursement Analytics (Network Economics)

Qualifications :

Required Qualifications - Must have:

• Bachelors degree in business accounting finance or related field or direct and applicable work experience.
• 4 years related work experience:
• In health care administration health insurance or related industry experience that demonstrates knowledge of claim submissions/forms provider contracting pricing billing reimbursement etc.; provider payment experience is strongly preferred.
• Participating in or leading projects/initiatives. Demonstrates key drivers of project management effectiveness.
• Strong technical analytical and diagnostic problem-solving skills attention to detail and desire to maintain customer and stakeholder satisfaction.
• Thinks creatively strategically and uses data to drive positive outcomes and improvements.
• Effective leadership experience in a formal or informal (e.g. program or project) leadership role. Ability to lead a diverse team through change.
• Proactive self-starter with effective time management and prioritization skills. Successfully manages and tracks projects.
• Excellent verbal and written communication skills including the development and delivery of presentations or provider communications. Effectively communicates with diverse internal/external audiences including executive leadership and is able to negotiate influence decisions and facilitate group discussions.
• Collaborative approach with ability to partner with different business areas to produce results.
• Proficiency with Microsoft Office including Excel Word and PowerPoint. Technical aptitude to learn systems quickly.
• Ability to travel (<5%) as needed.

Preferred Qualifications - Great to have:

• Bachelors degree in business accounting finance or related field.
• Formal leadership experience.

Additional Information :

What you will do:

a. Provide leadership and day-to-day management of financial and human resources primarily focusing on employee coaching development performance improvement coordination and budgeting for staff and department(s) specific functions/services. Support business objectives and produce results that are effective accurate timely and on target to meet business and stakeholder needs. Identify monitor and communicate critical business metrics to ensure project execution success and leverage results for future process improvements.

b. Analyze payment data to identify trends and make recommended changes to processes/policies and system design. Stay informed of health care industry related to payment and incorporate findings into strategic plans as appropriate.

c. Serve as a subject matter expert of Wellmarks provider payment and technical systems. Provide strategic consultation for the development implementation and maintenance of effective health networks.

d. Collaborate with key internal stakeholders and external vendor partners to develop implement and maintain provider payment methodologies tools and technical systems. Ensure all technical systems are synchronized and provider payment is in compliance with contractual obligations.

e. Manage and implement projects by managing interdependencies interrelationships requirements and solutions of multiple projects and systems. Leverage business resources effectively by continually supporting system development life cycle (SDLC) and the facilitation/coordination of multiple project schedules from a business and system perspective to ensure timelines and mandated dates are met.

f. Consult with externally facing divisions including Network Engagement and Sales to provide strategic consultation related to provider payment technical systems communications and inquiry resolution. Meet directly with providers as appropriate in designing and implementing strategic payment models evaluating additional network services and negotiating appeals and single case agreements.

g. Lead process improvement endeavors within the Network Economics department to initiate and implement improvements that support department and division goals. Ensure process improvement opportunities incorporate industry & market knowledge (best practices pricing methodology etc.).

h. Participate in division level strategy and structural development to support requirements relating to network payment and technical solutions.

i. Manage business relationships and day to day interactions with multiple vendor partners simultaneously. Ensure the desired programs and/or services are delivered based on agreed upon service level agreement standards and delivery expectations are met.

j. Other duties as assigned.

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit hire train and promote individuals in all job classifications without regard to race color religion sex national origin age veteran status disability sexual orientation gender identity or any other characteristic protected by law.

Remote Work :

No

Employment Type :

Full-time