Director, Provider Reimbursement and Contract Analysis- JHP

Director, Provider Reimbursement And Contract Analysis

The Director, Provider Reimbursement and Contract Analysis is responsible for developing reimbursement strategies and methodologies, network reimbursement / financial analyses, and related reimbursement operations. The position is responsible for oversight of all reimbursement functions for the HPP Pennsylvania provider network and future expansion markets.

Responsibilities include :

• Establishing reimbursement methodologies, strategies, and payment analysis for all provider types.
• Designing and overseeing payment methodologies to providers representing more than $1B annually.
• Developing reimbursement strategies and systems based upon a technical understanding of industry standards and innovative payment models, including specialized knowledge of Pennsylvania Medicaid and CMS Medicare payment methodologies.
• Developing financial models to support network negotiations and payment system strategies, including relative rate benchmarking.
• Developing and maintaining analytical processes to ensure claims payment integrity, including consistency with provider contracts and HPP payment policies.
• Developing and maintaining provider contract compensation exhibit templates, alternative reimbursement language library and ensuring contracted reimbursement terms can be successfully operationalized and automated.
• Working closely with the Provider Contracting team to coordinate the "end-to-end" contracting process.
• Participating in the Medical Cost Action Plan program, including implementing initiatives to reduce medical costs trends and identify opportunities for medical cost reductions.
• Coaching and leading team to continuously grow knowledge and analytical skills and improve operational performance.
• Recruiting, developing, motivating and retaining a high caliber of team members.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.