Status: Full-Time permanent position (40 hours)
Standard working hours: 8:00 am to 5 pm EST, M-F
Location: Remote opportunities are available in the following states: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming
Position Summary:
The Payment Policy Research/ Reimbursement Manager is responsible for the identification, development, and presentation of new policy-related medical cost savings opportunities. This position will assess new opportunities based on data reporting tools, policies, and industry trends. Researches and assesses payer policies and payment integrity solutions in relation to competitors and industry standards to identify new medical cost savings opportunities. Determines potential strategies and/or solutions to achieve identified cost savings such as policy development or enhancement, contract strategy and claims editing. Participates in analytical, experimental, investigative and other fact-finding work in support of opportunity development. Influence. Recommends changes to current policy development procedures based on market research and new trends. Serves as an industry thought leader and policy SME.
Education:
3 to 5 years related experience commensurate with requirements can be considered in lieu of degree.
Certification/Licensure:
Certified Professional Coder (CPC) - Certification - American Academy of Professional Coders (AAPC) preferred
Experience:
3+ years of experience with Healthcare payment policy and/or clinical policy REQUIRED
5+ years experience billing, coding, and/or auditing healthcare claims REQUIRED
Health Insurance Industry- 5 years REQUIRED
Project Management- Previous Experience REQUIRED
Reimbursement- Previous Experience REQUIRED
Statistics- Previous Experience REQUIRED
Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.
Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.
We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is: $ 79,497.6 min - $ 132,496 max. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!
To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-85683
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Talroo – Leadership
Keywords: Healthcare, Hospital, Health System, Remote, Payment, Policy, Manager, Reimbursement, Health Insurance, Billing, Coding, Claims, Clinical, Medical, Cost Savings, Certified Professional Coder, CPC, Managed Care, MCO, Health Plan, Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming
We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is:$79,497.60-$132,496.00. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.