Job Information
Healthfirst Director, Reimbursement Configuration in Hybrid, New York
Job Description
Duties & Responsibilities:
Drive flexible, repeatable and scalable claims configuration design and implementation processes with industry best-practices
Engage directly with other operational teams and leaders to provide input on the scope, approach, and timing of configuration work
Assess upstream and downstream impact of configuration and policy changes to proactively identify and mitigate risk
Manage interdependencies across other configuration units and business areas to ensure delivery timelines and project deadlines are met
Identify and resolve inconsistencies between system configurations and reimbursement contracts and policies
Maintain effective and consistent configuration testing protocols and quality controls
Manage and monitor team performance, production and quality
Establish structure for ongoing education, training and knowledge share across team
Prepare and present updates to the business and senior executives on configuration strategies, activities, and metrics
Lead and support company-wide initiatives
Work with internal and external parties to ensure claim payment logic and business rules are well understood and administered appropriately
Actively support all Compliance and Regulatory requirements with appropriate policies, processes, reports, and audit support.
Additional duties as assigned.
Minimum Qualifications:
Bachelor's Degree from an accredited institution or equivalent work experience
Proven experience in health insurance focused on claim configuration and reimbursement processes
Proficiency in provider contract reimbursement terms and code sets (HCPCS, ICD10, DRGs, CPT, etc.), and claims processing practices
Knowledge of medical claims and adjudication procedures, including the application of reimbursement and medical policy guidelines and contract pricing
Knowledge of claim payment methodologies and regulatory frameworks governing health plan reimbursement methods in Medicare, Medicaid and commercial insurance markets
Experience leading complex, technical, cross-functional programs and working with senior executives
Experience articulating complex issues to audiences with varying levels of technical expertise
Experience influencing leaders, breaking down barriers and managing competing priorities
Strong problem solving and analytical skills
Excellent communication and interpersonal skills
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
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