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  • Rapid City, SD

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Manager of Managed Care Reimbursement

Regional Health • Rapid City, SD

Posted 1 month ago

Job Snapshot

Full-Time
Healthcare - Health Services
Management

Job Description

Current Employees:

If you are a current employee, please apply via the internal career site by logging into your Workday Account and clicking the "Career" icon on your homepage.

Job Category

Revenue Cycle

Department

CS Managed Care

Scheduled Weekly Hours

40

Shift

Day (United States of America)

Employee Type

Regular

Job Summary

Oversees, leads and directs a contract analyst team. Responsible for complex financial and contract modeling to support negotiations, revenue cycle underpayments monitoring, reporting and pursuit of underpayments from payers when the payer is not in compliance with contract language and government reimbursement to prospectively and retrospectively audit and maximize revenue.

Job Description

Essential Functions

  • Key participant in external negotiations with payers, understanding contract modeling and being able to model contract scenarios during ongoing negotiation
  • Support in the payer contracting strategy development and communication to organizational senior leadership
  • Identify best practices and develop contract models within software tools, such as Epic, using current third-party payer contracts to measure reimbursement against contract provisions
  • Managing reconciliation of third party payments to optimize contractual reimbursement
  • Providing support to budgeting staff and other departments on contract modeling and analysis
  • Is able to manipulate and analyze large claims files from government and commercial payers to produce actionable reports on costs and utilization that supports management decisions
  • Model, audit and reconciles incentive arrangements with value based contracts.
  • Monitoring, reporting and pursuit of underpayments from payers when the payer is not in compliance with contract language
  • All other duties as assigned

Additional Requirements

Preferred:

Bachelor's in Finance

Master's in Healthcare

Make a difference.  Every day.

Regional Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.

Job ID: R7202
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