Director of Provider Reimbursement Development-Healthcare

Location: Pittsburgh, PA
Date Posted: 10-28-2016
General Overview:
This job is responsible for the direction and oversight of the departmental functions relating to provider reimbursement including research, development, implementation, ongoing operational maintenance and administration of provider payment methodologies and fee schedules for all provider types in support of provider contractual arrangements. Additional responsibilities of this job include the development and integration of provider payment policies and guidelines applicable to institutional and professional reimbursements and in concert with the Organization's products and member benefits. This job will partner closely in the pay for value reimbursement designs, and will contribute to the support other corporate short and long term strategic initiatives. These functions collectively maintain the Organization's reimbursements to all health care providers, and serve as a consulting resource in maintaining the Organization's application service providers partner plans.
 
Essential Job Functions:
Performs management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
Maintains all institutional reimbursement methodologies leveraged by the Organization and partners. This includes demonstrating deep knowledge in industry standard payment methods, including but not limited to: diagnostic related groups (DRG) weight-based methods, ambulatory payment classifications (APCs), fee schedules and other customized methods in support of contractual commitments.
Maintains all professional reimbursement methodologies leveraged by the Organization and Partners. This includes demonstrating deep knowledge in professional fee development for annual, quarterly and interim updates. This will also include deep understanding of industry standard methodologies, including but not limited to: resource based relative value scale (RBRVS), anesthesia, ancillary payment models and any other fee for service models.
Demonstrates working knowledge in the design and roll out of alternative payment methods that are focused on an incentive based pay for value approach. This will require partnering cross organizationally to support the development of these new programs, and direct the operational activities necessary to stand them up.
Works across the organization to aid to develop and manage payment policy across the organization. This includes assessment and recommendations for payment policies for all provider reimbursements that follow industry and corporate level guidelines. Will also play a key roll in the assisting the partners in maintaining their policies.
Researches and provides recommendations on development of new or enhancements to existing reimbursements in conjunction with corporate and contractual initiatives including sound financial modeling/impact analyses.
Operates as the divisional lead for the corporate affordability strategy, working collaboratively across all the the Organization's markets to identify, track and implement identified initiatives.
Other duties as assigned or requested.
 
Minimum Qualifications:
  • Bachelor's Degree and 8 years' of healthcare industry experience that includes 5 years' of extensive experience in provider payment and data analysis, strategic planning and financial management, with 3 years' staff, team lead or project lead experience OR;
  • GED/Diploma and 14 years' of healthcare industry experience that includes 5 years' of extensive experience in provider payment and data analysis, strategic planning and financial management, with 3 years' staff, team lead or project lead experience
  • Strong financial background and analytical skills with a deep understanding of the economic drivers of healthcare
  • Understanding of new and emerging trends in reimbursement and payment model design
  • Familiarity with core health plan reimbursement operations
 
Preferred Qualifications:
  • Master's Degree - Business, Finance, Healthcare Administration or other related field.
  • Familiarity with alternative care model designs (e.g., patient centered medical home, ACO), alternative reimbursement models (e.g., bundled payments), and provider / health plan quality programs (e.g. pay for performance)
  • Familiarity with the delivery of health care services across the continuum and quality metrics.
  • Experience working with technology vendors, and other service provider solutions to source key capabilities
  • Comfort and with real-time calculations of cost, membership, etc. (i.e., back of the envelope estimations)Experience working with technology vendors, and other service provider solutions to source key capabilities
Very competitive salary and benefits!
Great company to work for!
Full relocation package is available!
Don't miss out! Apply now and we'll be in touch immediately with more specific details, salary information and to answer any questions!!

This position does NOT provide sponsorship so please do NOT apply if you require sponsorship.  Thank You

KP Recruiting Group 
"Bringing Talent to the Marketplace"

KP Recruiting Group is a well established and very respected recruiting firm.  We have built a strong reputation as a premier resource for providing highly qualified candidates for our clients.  We are very experienced in many industries and have a wide range of clients.  We will serve as your advocate during your career search!  Let us do the work for you!  There is never a fee for our services!



 
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