Provider Reimburse Director Payment Integrity Strategy & Planning
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Job Location:
Wallingford, CT - USA
Monthly Salary:
Not Disclosed
Posted on:
16 hours ago
Vacancies:
1 Vacancy
Job Summary
Anticipated End Date:
Position Title:
Provider Reimburse Director - Payment Integrity Strategy & PlanningJob Description:
Provider Reimburse Director - Payment Integrity Strategy & Planning
Location: This role requires associates to be in-office 3 days per week fostering collaboration and connectivity while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment unless an accommodation is granted as required by law.
The Provider Reimburse Director leads key provider reimbursement functions and initiatives across the enterprise and serves as subject matter expert regarding provider reimbursement strategies and practices.
How you will make an impact:
Leads the development and implementation of enterprise-wide provider reimbursement strategies processes and systems for a major provider type such as facilities.
Works to drive the adoption and use of standardized reimbursement and contracting methodologies across the enterprise.
Works with medical directors contract negotiators cost of care staff and provider relations staff to identify and implement best practice solutions to manage costs and reimburse for services.
Facilitates the communication of activities emerging trends and best practices across all units and facilitates implementation of initiatives through use of a steering committee containing representatives from the companys plans regions and business units.
Researches and quantifies the impact of changes to reimbursement methodologies.
May lead fee schedule development for specific plan(s) and/or the development and implementation of clinical editing rules.
Manages special projects and initiatives.
Represents the department and serves as a key contributor on enterprise initiatives projects and task forces.
Oversees the gathering documenting and approving of policy-based implementation requirements.
Establishes standardized processes for policy edit requirements team and assures adherence to processes.
Minimum Requirements:
Requires a BS/BA degree in a related field and a minimum of 10 years business and professional experience in provider reimbursement and contracting provider relations and provider servicing; or any combination of education and experience which would provide an equivalent background.
Preferred Skills Capabilities and Experience:
MBA or BA/BS degree in Business Finance Economics or Healthcare Administration is highly preferred.
Experience in broad-based analytically oriented managed care payor or provider environment is strongly preferred.
Deep expertise in PI pre-pay editing implementing requirements and managing regular edit deployments strongly preferred.
Strong understanding of claims and claims processing preferred.
Knowledge and experience in the products and services of the respective industry strongly preferred.
Experience and knowledge of process improvement and change management experience (strategic and execution) strongly preferred.
Experience interacting confidently with senior management and executive level stakeholders as a subject matter expert and comfortable with influencing decision-making preferred.
Excellent written oral presentation and interpersonal communication skills with the proven ability to negotiate expectations between multiple parties strongly preferred.
Job Level:
Director EquivalentWorkshift:
1st Shift (United States of America)Job Family:
PND > Pricing ConfigurationPlease be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes including those submitted to hiring managers are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy power our business outcomes and drive our shared success - for our consumers our associates our communities and our business.
We offer a range of market-competitive total rewards that include merit increases paid holidays Paid Time Off and incentive bonus programs (unless covered by a collective bargaining agreement) medical dental vision short and long term disability benefits 401(k) match stock purchase plan life insurance wellness programs and financial education resources to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager associates are required to work at an Elevance Health location at least once per week and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age citizenship status color creed disability ethnicity genetic information gender (including gender identity and gender expression) marital status national origin race religion sex sexual orientation veteran status or any other status or condition protected by applicable federal state or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 Florida Agency for Health Care Administration.
Required Experience:
Director
Key Skills
About Company
Elevance Health, formerly Anthem, Inc., serves people across their entire health journey taking an integrated whole-health approach.
