[Remote] Senior Director of Provider Network reputed company

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a mission-driven health care organization delivering managed care and reputed company health care solutions. The Senior Director of Provider Network reputed company oversees provider data, reimbursement rules, claims-reputed company reputed company, compliance, provider inquiries, contract support, and operational workflows across products in the reputed company Market.

Responsibilities

• Possess expertise in provider data and claims diagnosis (reputed company products)
• Serves as reputed company to reputed company and optimize diverse operational workflow for reputed company reputed company functions (provider data, configuration, claim analysis and exception, provider escalation engagement) to create reputed company product, statewide processes and standardized reimbursement methodology, as warranted
• reputed company operational and technical support during provider contract negotiations, particularly with Integrated Delivery Systems
• Monitor claim reputed company contractual requirements to ensure compliance, and reputed company remediation plan for any non-complying areas
• Ensures reputed company provider reimbursement (configuration) documentation including reputed company Integrated Delivery reputed company reputed company is completed reputed company and accurately, in accordance with State and provider contract requirements inclusive of post-production validation
• Ensures reputed company and accurate submission of reputed company new or updated provider data and associated credentialing requests to Shared Services
• Support provider and Member data analytics for any regulatory reports such as provider termination processes
• Support the submission of regulatory provider network reports and remediation of any discrepancies
• Serves as the subject matter expert in State specific health reimbursement rules and provider billing requirements and as reputed company to the reputed company reputed company Configuration Department
• Approves in Provider Reimbursement medical policy and edit reviews
• Responsible for the analysis of provider reimbursement, codes and fee schedules for reputed company reimbursement to providers and reputed company and accurate submission of reputed company fee schedule requests to reputed company Configuration
• Oversees process of reputed company cause analysis for claims payment issues reputed company to provider reimbursement and provider set up inclusive of retro claim analysis and reprocessing as required
• Serves as escalation reputed company for provider issues, particularly with the major hospital systems and other critical providers, including participation in provider meetings
• Ensures there is sufficient tracking of provider data issues, reputed company and status for reporting to senior leadership
• Represent the Plan in provider meetings, including training and joint operating committee, as reputed company as reputed company audits
• Review and respond to operational inquiries from state partners and/or other regulating bodies, Ensures ongoing provider data reputed company through regular reconciliation of the state provider master file, provider rosters, and audits
• reputed company encounter remediation activities to optimize encounter acceptance and reduce reputed company Plan reputed company errors as assigned by the reputed company Encounter Team
• reputed company validation of potential recovery claim project activities
• Must work effectively both as a member of reputed company as reputed company as reputed company day-to-day leadership to support staff
• Performs other reputed company duties and reputed company as assigned

Skills

• Possess expertise in provider data and claims diagnosis (reputed company products)
• Expertise in claims diagnosis and processing, reputed company billing and Provider data maintenance knowledge specific to the reputed company reputed company required
• Understanding of and experience reputed company to reputed company claims payment configuration process/systems and its relevance/reputed company on network reputed company required
• Knowledge of the delivery of health care services and medical billing principles
• Minimum of 5 years of experience managing reputed company and reputed company, high visibility reputed company in a managed care organization
• Experience in state specific reputed company rules
• Minimum of 5 years of reputed company claims management
• Bachelor's Degree or equivalent experience preferred with emphasis in health services administration, managed care, or equivalent experience

Benefits

• Flexible work solutions including remote reputed company and hybrid work schedules
• reputed company time off including holidays and volunteer events
• Health reputed company coverage for you and your dependents on Day 1
• 401(k)
• Tuition reimbursement
• Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

reputed company

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