Healthcare Reimbursement Strategy Consultant

Provider Relations
14554 Requisition #
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Healthcare Reimbursement Strategy Consultant
Job Summary
This role will lead the development and execution of the provider reimbursement strategies in alignment with the Organization’s products and networks.  This position will partner closely with key business functions to integrate industry knowledge in order to enable short and long term strategic initiatives. This function will collectively lead, enable, maintain and support the Organization's reimbursement for all health care providers.
Essential Functions 
  • Establish the Network Management strategic reimbursement vision, objectives, and policies and procedures
  • Partner closely with  functional teams to formulate provider reimbursement approaches in alignment with Organization’s initiatives and strategies
  • Perform periodic analyses of the provider network to evaluate current reimbursement to industry approaches and standards
  • Provide leadership and industry expertise in evaluating opportunities to expand or change the reimbursement approaches to meet the Organization’s goals
  • Establish and oversee reimbursement controllership for hospital, ancillary, professional and value based contracts
  • Conduct regular reviews of provider reimbursement to ensure strategic focus is on target with overall strategy
  • Support reimbursement strategies of new market expansion
Position Requirements
  • Bachelor’s degree or equivalent work experience
  • Experience in the healthcare industry including extensive experience in provider reimbursement and provider contracting and/or strategic planning
  • Expert level knowledge on provider reimbursement and contracting methodologies (MACRA, MIPS, Value Based Reimbursement, Capitation, Diagnosis Related Groups (DRGs), Resource-Based Relative Value Scale (RBRVS))
  • Strong financial background and analytical skills with deep understanding of the economic drivers of healthcare
  • Understanding of new and emerging trends in reimbursement, payment model and contract design.
  • Expert level proficiency of Microsoft Office (Word, Excel, PowerPoint and Outlook)
  • Exceptional presentation, written and verbal communication skills
  • Evidence of positive collaboration with a broad spectrum of individuals and departments.
  • Demonstrated ability to establish, implement and manage effective work processes within a large organizational structure.
  • Demonstrated ability to prepare and execute sound business plans and strategies 
  • Master's degree

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