Devoted Health · 4 hours ago

Provider Payment Performance, Senior Manager

United States

Full-time

Remote

Mid, Senior Level

$105K/yr - $155K/yr

5+ years exp

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Comp. & Benefits

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Responsibilities

Proactively monitor provider performance and provide actionable insights to leadership and the Payment teams to resolve issues and improve payment accuracy.

Perform in-depth analyses to identify the root causes of high denial rates, including coding errors, billing practices, policy adherence or medical necessity determinations.

Regularly report on payment rate performance and claims denial trends to senior management, offering insights and proposing solutions for continuous improvement.

Provide ongoing feedback to internal stakeholders on how to streamline payment processes, improve claim submission accuracy, and reduce unnecessary denials.

Lead the development of reporting dashboards and key performance indicators (KPIs) to monitor provider payment rates, claim denial trends, and related operational metrics.

Develop ad hoc reports as needed to support decision-making and problem-solving related to provider payment rates and claims management.

Serve as a subject matter expert on claims denials and provider payment rate issues, leading internal teams through corrective actions and process optimization.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Medicare claims processingProvider payment modelsContractual agreementsData analysis toolsHealthcare experienceExcelSQLTableauHealthcare AdministrationFinanceHealth Insurance certificationMedical Coding certificationClaims Management certificationRevenue Cycle Management certificationRoot cause analysisProcess improvement techniquesSix SigmaLeanCross-functional collaboration

Required

Strong understanding of Medicare claims processing, provider payment models, and contractual agreements.

5-10 years of Healthcare Experience.

Advanced proficiency with data analysis tools (Excel, SQL, Tableau), and reporting systems.

Excellent analytical skills, with the ability to interpret complex data, identify trends, and provide actionable insights.

Ability to collaborate effectively with cross-functional teams (e.g., Claims, Contracting, Provider Services, Compliance) and external providers.

Strong communication and presentation skills, with the ability to explain complex payment and claims issues to both internal stakeholders and external providers.