Provider Reimbursement Policy Manager- Patient Safety
Core
Develops and maintains provider reimbursement policies to ensure accurate claims adjudication, lower cost of care, and reduce administrative expenses by translating complex coding and billing rules into effective strategies.
Role type
Senior IC provider reimbursement policy manager
Builds
Provider reimbursement policies and behavioral health reimbursement rules
Domain
Healthcare insurance / Medical billing and coding
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Financial modeling, economic analysis, claims adjudication, behavioral health standards, billing rules, coding conventions, cost of care analysis, policy development
Preferred skills
Certified Professional Coder (CPC), clinical background, patient safety experience, pricing methodologies (ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG), research and analysis
Technologies
ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG
Responsibilities
Leads policy development for specific plans and behavioral health reimbursement rules; works with business areas to incorporate cost of care targets into financial plans; performs complex research to ensure projected changes meet corporate cost targets; prepares and presents cost of care data analysis; develops policies to lower cost of care and improve service; manages special projects and initiatives
Seniority
Senior, hands-on IC