Manager, Reimbursement Systems Configuration

About the role:

As a member of the Network Pricing and Reimbursement team, the Manager of Reimbursement Systems Configuration plays a crucial role in leading the setup, implementation and maintenance of the XO Health reimbursement system configuration.  This role is responsible for leading, designing, implementing and maintaining the configuration of the pricing software to meet the specifications of contracts and/or XO Health pricing strategy. The Manager will lead, formulate and define the elements of scope and objectives, combined with an understanding of applicable business systems, industry requirements and collaboratively work with matrix partners to produce the desired reimbursement result.

Responsibilities:

• Serves as the primary relationship interface between Benefits, IT, Claims Operations, and the business.
• Acts as a key informant to the organization or providers and participates with other stakeholders across Provider Payment Operations, Benefits, IT, Network Performance other divisions in the identification of strategic business solutions for provider reimbursement strategies.
• Proactively defines overall direction, roadmap and improvement actions for provider reimbursement applications that are core to XO Health business.
• Leads the development of scripting of reimbursement related applications.
• Provides daily leadership, performance feedback, mentorship, training and coaching to a team of Reimbursement Analysts.
• Communicates with team leads, management, IT, and business leadership to drive the coordination of processes across the enterprise.
• Ensures that governance, validation and quality processes are in place to support the highest level of accuracy within owned applications.
• Validates the quality of work performed by staff in their functional area.
• Manages development of best practice Pricer configuration for complex contracting and negotiations for multiple provider payment methods.
• Participates in developing As-Is and To-Be process flows.
• Creates and reviews test cases that are planned and executed. Manages root cause analysis of defects found during testing and corrects.
• Performs feasibility analysis based on an understanding of proposed methodologies.
• Drives solutions of production issues based on an in depth understand of systems and systems functionality.
• Communicates business information, technical information and developments to users and technical staff in both verbal and written form; provides or coordinates feedback to management and/or users on all open issues.
• Uses data and other information to influence the appropriate decision.
• Manages internal master pricing tables and creates workflow and timeline for required updates.
• Manages maintenance of pricing tables, with timely and accurate loading to support the pricing lifecycle;

Qualifications:

A qualified candidate will likely have:

• Bachelor’s degree from an accredited university or college in Healthcare Administration, Business, Information Systems or a related academic field or 10+ years configuring Pricer software (provider reimbursement/agreements) in lieu of degree.
• 10+ years’ experience with payment methodologies, and network management experience for various provider types.
• 8+ years of experience interpreting complex contract language and intent specific to provider reimbursement.
• 8+ years of experience working in the healthcare industry.
• 5+ years with extensive knowledge of claims processing / billing.
• Proficient Experience in Microsoft Windows, Excel, Word, PowerPoint and Access (or similar applications) with the ability to create queries and advanced complex formulas.
• 5+ years of experience configuring Pricing software (provider reimbursement / agreements).
• Experience with CMS reimbursement methodologies.
• Working knowledge of medical terminology, code updates, data warehousing, operational systems, internet application concepts.
• Knowledge of the software development lifecycle and structured software development methodologies.
• Demonstrated ability to work in a fast-paced, evolving environment while managing multiple priorities.

Key personal and professional attributes:

• Can work collaboratively internally and externally.
• Is self-assured, self-directed, and results oriented.
• Brings Strong analytical and problem-solving skills.
• Has commitment to the startup.