• Manager of Provider Reimbursement

    Req No.
    2018-3597
    Company
    Community Care Collaborative
    Job Locations
    US-TX-Austin
    Category
    Professional
    Type
    Regular Full-Time
  • Overview

    Manages the activities of claims administration, contracted provider reporting and processing of invoices for non-claim services. Serves as a liaison between the Third Party Administrator (TPA), contracted providers, and CCC staff to manage provider reimbursement process, including acting as the first point-of-contact with providers to identify and resolve reimbursement issues.

     

    Responsibilities

    Has a wide variety of responsibilities related to managing relationships with our healthcare service providers as well as handling management of our Third Party Administrator (TPA).

     

    Duties and responsibilities include:

    • Delivers excellent customer service and helps build positive relationships with the CCC provider network by effectively resolving issues and coordinating a smooth reimbursement process;
    • Develops and maintains policies and procedures relevant for all job duties and responsibilities, and cross-trains other staff to ensure continuity with same;
    • Manages the claims processing for health care services, including oversight of the CCC's Third Party Administrator (TPA) contract and the CCC's internal, manual claim/invoice processing systems;
    • Reviews “Request for Funding” files from the TPA for identification of claims adjudication issues and for accuracy of new contract implementations and TPA configurations;
    • Coordinates the configuration process of providers and benefits with the TPA
    • Resolves financial and operational reimbursement issues associated with each contract;
    • Ensures the accuracy of the CCC online MAP Provider Manual. Directs and monitors staff conducting new provider orientations and in-service training; and
    • Manages the encounter data and other file exchange from various sources within the CCC.
    • Works with analytics staff to define reports/dashboards and review with CCC staff.

    Performs other duties as directed by the CCC Leadership, and as otherwise required.

     

    KNOWLEDGE, SKILLS, AND ABILITIES

    • Knowledge of the principles and practices of claims processing and payments;
    • Knowledge of the principles and practices of managed care contracting, provider reimbursement and claims; payment, medical terminology and health care delivery systems;
    • Knowledge of principles and practices of public sector procurement and contract administration;
    • Ability to provide guidance and direction to subordinates, including setting performance standards and monitoring subordinates;
    • Knowledge of general contracting principals, financial & operational procedures and practices; and
    • Strong communication skills, including a proficiency in drafting business memos, contractual language, email, and in-person with facilitated meetings.

     

    Physical Abilities:
    • While performing the duties of this job, the employee constantly is required to: grasp, handle, feel, see, and sit;
    • The employee frequently is required to: reach, walk, talk, and listen; and
    • The employee occasionally is required to: lift up to 25 pounds.

    Qualifications

    • Bachelor's degree in a related field of study or equivalent additional years of experience
    • Minimum of five years of combined claims review and/or vendor/contract reimbursement management experience in a managed care environment
    • Additional experience in a healthcare setting from the point of view of care delivery is a plus
    • Knowledge of medical claim coding is a plus
    • Demonstrated experience supervising staff preferred

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