Director, Enterprise Reimbursement Strategy

• Development and implementation of strategic initiatives to control unit medical costs.
• Evaluation of annual CMS reimbursement guidelines and recommendations as they relate to control over medical claims cost.
• Research and develop new contracting and reimbursement methodologies.
• Facilitates the communication of activities, emerging trends, and best practices with provider solution leadership across all lines of business.
• Directs the daily interaction with and requests for reimbursement subject matter expertise and support.
• Oversee and prioritize workflow.
• Coordinates with Reimbursement Policy/Edit team as necessary to achieve strategic reimbursement related goals.
• Works closely with CoC team on PADU (Preferred/Acceptable/Discouraged/Unacceptable).
• Hires, trains, coaches, counsels, and evaluates the performance of direct reports.

• Requires a BA/BS degree in Business, Finance, Economics, or Healthcare Administration
• a minimum of 10 years of related experience in broad-based, analytically oriented, managed care payor or provider environment required
• Experience must include project management, CMS payment methodology application, and financial/economic business modeling
• Advanced knowledge of managed care provider and claims payment systems and process is essential and strongly preferred
• CPA, MBA or other equivalent advanced degree is preferred

Demonstrates expertise in strategic initiatives for controlling medical costs, with a strong focus on CMS reimbursement guidelines and managed care payment systems. Proven ability to lead teams, manage projects, and develop innovative reimbursement methodologies.

• Strategic Initiative Development
• CMS Payment Methodology Application
• Project Management
• Managed Care Provider Knowledge
• Financial/Economic Business Modeling

• Financial Modeling
• Reimbursement Methodologies
• Claims Payment Systems
• Cost Control Strategies
• Data Analysis

• Team Leadership
• Communication
• Coaching
• Performance Evaluation
• Collaboration

• CPA
• MBA

• Managed Care
• Healthcare Administration
• Provider Solutions
• CMS Reimbursement Guidelines
• Workflow Coordination