Senior Provider Engagement Specialist
Columbus, OH 43085
- 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.