Supervisor Priority Health Provider Reimbursement

Job Summary

Supervises the provider contract reimbursement set up and ensures the configuration aligns with the provider payment and billing policies. Manages department objectives by creating, maintaining, and monitoring policies, procedures, metrics, and guidelines. Collaborates with provider network contracting and provider enrollment teams to ensure high levels of quality and efficient work is in place.

Essential Functions

• Accountable for resolution of implementation and support issues, leader of collaboration with support teams to troubleshoot and resolve escalated incidents and problems, using established procedures for problem and situation management.
• Serves as a resource to all team members. Mentors new staff, and less experienced team members, and serves as a role model for customer service excellence.
• Monitors federal regulatory changes and other appropriate sources for rule revisions associated with payment policies.
• Lead small scale project and process implementation by identifying tasks, dependencies, responsibilities, quality checks and milestones. Identify issues and drive resolutions.
• Participates in core work groups to recommend and direct process development. Identifies needs, develops, and conducts education, orientation, and training, establishes evaluation and effectiveness measurement.
• Works closely with Provider Reimbursement Manager to ensure all established procedures and workflow are followed within the department.
• Participates in committees related to the team to provide feedback and ensure that the department is represented in corporate-wide activities and functions.
• Support value stream teams in analyzing business functional details requirements for complex corporate initiatives and helps articulate technical and business non-functional requirements. Helps solve problems bringing business expertise and understanding of holistic impacts to ensure business outcomes are achieved.
• Extensive and comprehensive knowledge of business processes, including but not limited to provider reimbursement methodologies, provider data, provider networks, and claims processing.
• Strong analytical and systems/relational analysis skills.
• Exceptional written and verbal communication skills.
• Proven team leadership skills to influence and guide team members toward department goals.
• Proven competency in analyzing business needs and working across both technical and nontechnical teams.
• Knowledge of Facets Medical Agreement application, and NetworX application.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance
• Traditional and Roth retirement options with service contribution and match savings

Qualifications

Required

• Bachelor's Degree or equivalent
• 3 years of relevant experience working with UB04 facility billing or professional CMS-1500 billing
• 3 years of relevant experience working with provider reimbursement methods in Medicare/Medicaid/Commercial spaces
• 7 years of relevant experience using Microsoft applications including Word, PowerPoint, Excel and Business Objects

Preferred

• Supervisor and/or leadership experience
• In-depth knowledge of Facets data structures, systems flows and process flows, including knowledge of third party integrated and target systems.
• Knowledge of Facets Medical Agreement application, and NetworX application
• Ability to use SQL for data to support decision-making.

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

Primary Location

SITE - Priority Health - 1241 E Beltline - Grand Rapids

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