Jefferson Health · 1 day ago
Director, Provider Reimbursement and Contract Analysis- JHP
Philadelphia, PA
Full-time, Contract
Onsite
Director/ExecutiveJefferson Health is a nationally ranked healthcare system dedicated to providing high-quality clinical care and education. The Director, Provider Reimbursement and Contract Analysis is responsible for developing reimbursement strategies and overseeing reimbursement functions for the provider network, ensuring payment integrity and operational efficiency.
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
Required
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
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
Medical (including prescription) insurance
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
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
ANTHONY S. NAH, Jr., B.S., MSc.
President / CEO
Ron Kumor
President/ CEO Aria Jefferson Health Physician Services and Senior Vice President, Network Dev
Recent News
Philadelphia Business Journal
2025-03-26
2024-04-29
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