Overview:
Now hiring a Manager Reimbursement.
Accountable for direct management and cross-departmental organizational leadership to achieve highly effective administrative implementation and up-to-date industry-standard interpretation of reimbursement agreements with network providers
How you belong matters here.
We value our employees' differences and find strength in the diversity of our team and community.
At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.
Why Join Us
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Full Time - Exempt: Yes
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Job is based Rev Hugh Cooper Admin Center
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Work hours: Days
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Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
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Remote: Open to remote applicants in the United States, except for the following states: Wyoming, North Dakota, and Ohio
Ideal Candidate:
Minimum of 5 years of experience with progressively increasing responsibilities in a function involving automated administration of high-volume transaction processing, preferably involving health care provider reimbursement (e.g. provider revenue cycle, or health insurance claims)
Knowledge and creation of different reimbursement methodologies such as RBRVS, Medicaid and Multiple CMS fee schedule such as OPPS, ASC, Clinical Lab etc..
Qualifications:
- Bachelor Degree.
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Undergraduate degree in Business, Accounting, or Healthcare Management related field or equivalent work experience required.
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Minimum of 5 years of experience with progressively increasing responsibilities in a function involving automated administration of high-volume transaction processing, preferably involving health care provider reimbursement (e.g. provider revenue cycle, or health insurance claims).
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Required: Proficiency in MS Excel.
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Preferred: Certification in correct coding practices (RHIA, RHIT, CPC, etc.), and/or expertise in healthcare transaction coding gained from experience in health plan claims, provider revenue cycle, provider contracting, etc.
Preferred: Experience and Certification in statistically-based quality control or business process improvement techniques.
Responsibilities:
- Business Process Owner for PHP s provider reimbursement administration process. Assure the effective and accurate transmission of provider reimbursement agreement parameters through a multi-departmental chain of activity including but not limited to:
Configuration of reimbursement parameters for auto-adjudication in PHP s claims system (Facets).
Establishment of manual processing rules for non-auto-adjudicated claims.
Communication of reimbursement terms and conditions to service departments with provider contact.
Oversight of corrective actions addressing errors in reimbursement. -
Exercise collaborative but authoritative leadership in cross-departmental work groups formed to streamline and reduce variation in the above processes.
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Directly manage a team of reimbursement and coding Subject Matter Experts, and authoritatively support and influence other work teams in PHP (IT/Configuration, Provider Network Management, Provider Contracting, Claims, etc.) regarding appropriate interpretations of provider reimbursement agreements and correct coding practices.
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Manage audits designed to assure that reimbursement policies and procedures are administered effectively, addressing both process and outcome measures. Define and implement process improvements as needed to address outcome deficiencies.
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Perform other duties as assigned
Benefits:
All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.
Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
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Maximum Offer for this position is up to: USD $51.41/Hr. Compensation Disclaimer: The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.