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Jefferson Health · 1 week ago

Director, Provider Reimbursement and Contract Analysis- JHP

Philadelphia, PA

Full-time, Contract

Onsite

Director/Executive

Jefferson Health is a nationally ranked health care system dedicated to providing high-quality clinical care and education. The Director of Provider Reimbursement and Contract Analysis is responsible for developing reimbursement strategies and overseeing reimbursement operations for the Pennsylvania provider network and future expansion markets.

Hospital & Health Care

Responsibilities

Responsible for establishing reimbursement methodologies, strategies, and payment analysis for all provider types

Responsible for the design and oversight of payment methodologies to providers representing more than $1B annually

Develop reimbursement strategies and systems based upon a technical understanding of industry standards and innovative payment models, including specialized knowledge of Pennsylvania Medicaid and CMS Medicare payment methodologies

Develop financial models to support network negotiations and payment system strategies, including relative rate benchmarking. Works with the contracting team to evaluate contract proposals

Develop and maintains analytical processes to ensure claims payment integrity, including consistency with provider contracts and HPP payment policies

Develop and maintains provider contract compensation exhibit templates, alternative reimbursement language library and ensures contracted reimbursement terms can be successfully operationalized and automated

Work closely with the Provider Contracting team to coordinate the “end-to-end” contracting process. This includes oversight of provider contract and fee schedule system configuration, related quality assurance procedures, and enforcing adherence to associated policies and procedures

Participate in the Medical Cost Action Plan program, including implementing initiatives to reduce medical costs trends and identify opportunities for medical cost reductions

Coach and lead team to continuously grow knowledge and analytical skills and improve operational performance

Recruit, develop, motivate and retain a high caliber of team members

Qualification

Reimbursement methodologiesFinancial analysisContract negotiationPayment analysisAnalytical processesCoaching skillsRecruitment skillsTeam leadership

Required

Develop reimbursement strategies and methodologies

Conduct network reimbursement / financial analyses

Oversee all reimbursement functions for the HPP Pennsylvania provider network and future expansion markets

Establish reimbursement methodologies, strategies, and payment analysis for all provider types

Design and oversee payment methodologies to providers representing more than $1B annually

Develop reimbursement strategies and systems based upon a technical understanding of industry standards and innovative payment models

Possess specialized knowledge of Pennsylvania Medicaid and CMS Medicare payment methodologies

Develop financial models to support network negotiations and payment system strategies

Work with the contracting team to evaluate contract proposals

Develop and maintain analytical processes to ensure claims payment integrity

Ensure consistency with provider contracts and HPP payment policies

Develop and maintain provider contract compensation exhibit templates

Maintain an alternative reimbursement language library

Ensure contracted reimbursement terms can be successfully operationalized and automated

Coordinate the 'end-to-end' contracting process with the Provider Contracting team

Oversee provider contract and fee schedule system configuration

Implement quality assurance procedures and enforce adherence to associated policies and procedures

Participate in the Medical Cost Action Plan program

Implement initiatives to reduce medical costs trends

Identify opportunities for medical cost reductions

Coach and lead team to continuously grow knowledge and analytical skills

Improve operational performance

Recruit, develop, motivate and retain a high caliber of team members

Benefits

Medical (including prescription)

Supplemental insurance

Dental

Vision

Life and AD&D insurance

Short- and long-term disability

Flexible spending accounts

Retirement plans

Tuition assistance

Voluntary benefits

Tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service

Company

Jefferson Health

Thomas Jefferson University and Thomas Jefferson University Hospitals are partners in providing excellent clinical and compassionate care for our patients in the Philadelphia region, educating the health professionals of tomorrow in a variety of disciplines and discovering new knowledge that will define the future of clinical care.

Founded in 1995