Senior Provider Engagement Specialist

Columbus, OH 43085

Post Date: 02/21/2018 Job ID: 26088 Category: Professional

Job Description:
  • Serve as the subject matter expert on issues related to provider reimbursement.
  • Evaluate the effectiveness of contracting strategies, payment methodologies and rates in comparison to budget of quality initiatives.
  • Establish financial benchmarks for provider reimbursement and analyze the impact of contracts submitted by the Health Plans.
  • Manage and modify the process for changes to outcomes analysis reports due to various needs and concerns.
  • Prepare and present information on emerging and industry standard reimbursement methods, competitive information, and national initiatives to management in support of network strategy discussions.
  • Oversee various projects including the design of physician incentives and other contractual arrangements.
  • Maintains divisional provider reimbursement models providing analytic reporting capabilities for contracting staff, contract settlement, incentive pool distribution, and estimation of savings through a variety of proposed contract/reimbursement actions.
  • Perform analyses of Health Plan reimbursements in comparison to national experiences.
  • Develop, export and train Health Plan financial analysts on the use financial modeling tools for provider reimbursement and medical expense forecasting.
  • Assist with formulating and administering organization policies and procedures.

  • Bachelor s degree in related field or equivalent experience.
  • 6+ years of provider reimbursement and analysis, application development, data/contract analysis and data mining or statistics, preferably in the healthcare industry.
  • Working knowledge of contract management processes, claims processing procedures, reimbursement and payment methodologies, and claims systems requirements and controls.
  • Experience with statistics and the application of higher level mathematical models to medical and pharmacy claims data.

For more information, please contact A-Line Staffing at 877-782-3334.


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