Remote Provider Payment Strategy Manager

Summary

The job is for a Provider Payment Strategy Manager at Central California Alliance for Health (the Alliance). The role involves managing provider reimbursement methodologies, providing guidance on departmental operations, and supervising assigned staff. The ideal candidate should have knowledge of various aspects related to provider reimbursement, pricing, and fee schedules, as well as experience in a managed care environment.

Requirements

• Knowledge of principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers
• Knowledge of provider contracting, including language, reimbursement methods, and rates
• Knowledge of healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical and provider data
• Knowledge of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), ICD 9/10 and CPT codes, and industry standard groupers, such as ETGs, DRGs, and DCGs
• Knowledge of general health service research, healthcare analytics and analysis, outcomes reporting/analytics, and program outcomes evaluation

Responsibilities

• Managing the advancement of provider reimbursement methodologies to align with organizational strategies and objectives, including value-based payment, and advising executive leadership regarding the feasibility of various strategies and methodologies
• Utilizing a variety of methods and models to evaluate the feasibility of reimbursement methodologies
• Providing management oversight and guidance related to the provider reimbursement function, acting as a subject matter expert, and providing guidance on departmental operations
• Managing, supervising, mentoring and training assigned staff

Benefits

• Medical, Dental and Vision Plans
• Ample Paid Time Off
• 12 Paid Holidays per year
• 401(a) Retirement Plan
• 457 Deferred Compensation Plan
• Robust Health and Wellness Program
• Onsite EV Charging Stations