Manager, Healthcare Provider Contract and Pricing
Full Time
Remote
Posted
Job description
The
Manager, Healthcare Provider Contract and Pricing has responsibility for managing staff and creating an infrastructure to support Performant’s claims repricing and contract audits ensuring the needs of the business are met for successful daily operations of healthcare audit and recovery. Demonstrates knowledge and expertise in carrying out the following scope of responsibilities:
Oversee team functions including, but not limited to:
Interpretation (and documentation of) provider contract payment information for use by the complex and automated teams
Development of algorithms to identify inappropriate payments
-QA of fee schedule loads - Analysis of data results to ensure accuracy of contract interpretation and system loads
Creation and processing of system files, and needed workflows using available tools, specific layouts, conditions, and instructions to create overpayment files
Responses to internal and external questions regarding data results and pricing calculations
Participate in the development or analysis of new/changing concepts and related data
Concept research and application of appropriate Medicare, Medicaid and other regulatory policy and rules
Conducting sample tests to prove and quantifying the value of concepts
Hires, trains, and develops staff; proactively manages team performance against objectives and deliverables to ensure high quality output meets business needs, and: resolves conflict in a tactful and effective manner.
Develops and ensure training and support to new team members as well as all team members for any new or changing workflows or requirements
Develop and maintain infrastructure tools and documentation as well as contribute to the development and/or improvement based upon changing requirements and/or new client requirements/contracts.
Drives research, analysis and resolution of complex questions, issues, and needs that arise.
Drives continuous improvement efforts and develops/delivers tools and training to increase knowledge, efficiency, and consistency of department output.
Applies strong communication and interpersonal skills to develop professional relationships and collaborate effectively with internal department leaders/staff, as well as clients and other external stakeholders and service providers.
Maintain current knowledge of and compliance with company policies, processes and procedures, Medicare/Medicaid rules, regulations, policies and procedures, contract requirements, and HIPAA certification; and ensures team members do the same.
Keeps abreast of medical practice, changes in technology, and regulatory concepts, or changes in reimbursement that may affect the Client contracts.
Completion of Teleworker Agreement upon hire, and adherence to the Agreement (and related policies and procedures) including, but not limited to: able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with HIPAA, safety & ergonomics, confidentiality, and dedicated work focus without distractions during work hours.
Other Duties as assigned
Note - All employees and contractors for Performant Financial may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Performant’s policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.
-QA of fee schedule loads - Analysis of data results to ensure accuracy of contract interpretation and system loads
Required Skills and Knowledge:
Physical Requirements
**NOTE: Must be able to meet requirements for and perform work assignments in accordance with Company policies and expectations on a home remote basis (and must meet Performant remote-worker requirements) until at which time staff will be notified and required to work from a Performant office location. Basic office equipment required to perform remote work is provided by the company.
Education and Experience:
Other Requirements
No work authorization sponsorship available.
NO AGENCY submissions without current vendor agreement AND approved Job Order for this requisition.
Job Profile is subject to change at any time.
Performant Financial Corporation is an Equal Opportunity Employer. Performant Financial Corporation is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.
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