Provider Reimbursement Manager
Location: Scotts Valley, California, or Salinas, California, or Merced, California
We have an opportunity to join the Alliance as the Provider Reimbursement Manager in the Financial Planning and Analysis Department.
WHAT YOU'LL BE RESPONSIBLE FOR
Reporting to the Financial Planning and Analysis Director, you will:
- Manage the advancement of provider reimbursement methodologies to align with organizational strategies and objectives, including value-based payment, and advises executive leadership regarding the feasibility of various strategies and methodologies
- Utilize a variety of methods and models to evaluate the feasibility of reimbursement methodologies
- Provide management oversight and guidance related to the provider reimbursement function, act as a subject matter expert, and provide guidance on departmental operations
- Manage, supervise, mentor and train assigned staff
ABOUT THE TEAM
We ensure the Alliance's stewardship of appropriate use of public funds through recoveries, coordination of benefits, contract negotiations and insurance.
To learn more about the Alliance at a glance, visit our quarterly fact sheet here.
WHAT YOU'LL NEED TO BE SUCCESSFUL
To read the full position description, and list of requirements click here.
- Knowledge of:
- Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers
- Provider contracting, including language, reimbursement methods, and rates
- Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical and provider data
- Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), and ICD 9/10
- General health service research, healthcare analytics and analysis, outcomes reporting/analytics, and program outcomes evaluation
- Medi-Cal and Medicare benefits
- Ability to:
- Develop work plans and workflows and organize and prioritize provider reimbursement activities
- Train, mentor, supervise, and evaluate the work of staff, promote an atmosphere of teamwork and cooperation, and motivate staff to achieve goals and objectives
- Negotiate value-based provider reimbursement rates and assist with the development of related contract language
- Apply analytical and pricing expertise to the evaluation, negotiation, implementation, and maintenance of managed care contracts
- Manage the development and implementation of projects, systems, programs, policies, and procedures
- Education and Experience:
- Bachelor’s degree in Finance, Economics, Accounting, Health Care or a related field
- A minimum of six years of experience performing provider reimbursement activities, including a minimum of two years of experience in a managed care environment, and some lead or
supervisory experience; (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying
- While this position is connected to one of our Alliance offices, we are in hybrid telecommute work environment right now and we anticipate that the interview process will take place remotely.
- Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.
- Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process.
COVID-19 Vaccine Requirement: At this time, this position requires vaccination or regular testing upon office entry. Fully vaccinated and boosted is defined as receipt of the second dose in a 2-dose series (ex: Pfizer & Moderna vaccines) OR receipt of a single-dose vaccine (ex: Johnson & Johnson); AND receipt of the booster (if eligible); AND a 2-week period having passed since the administration of the last vaccine dose. If you state that you are vaccinated, proof of vaccination must be submitted at time of hire.
Additionally, all positions at the Alliance are required to meet these minimum qualifications.
- Medical, Dental and Vision Plans
- Ample Paid Time Off
- 11 Paid Holidays per year
- 401(a) Retirement Plan
- 457 Deferred Compensation Plan
- Robust Health and Wellness Program
- EV Charging Stations
- And many more
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Merced, Monterey and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet.
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.
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