responsible for managing key components of the provider reimbursement strategy and policy
Ensures accurate adjudication of claims
translating various complex coding, business and billing rules and standards into effective and accurate reimbursement policies
Serves as subject matter expert regarding reimbursement policies, edits, behavioral health standards, billing, and coding conventions
Leads policy development for specific plan(s) and/or the development and implementation of behavioral health reimbursement policy rules
Works with the multiple business areas to ensure that accurate cost of care targets are incorporated into the company's financial plans
Performs and/or directs complex research to ensure that projected changes meet corporate cost targets.
Prepares and presents cost of care data analysis to support the regions cost of care initiatives.
Develops and maintains the provider reimbursement policies that will lower the cost of care, improve service, and reduce administrative expenses.
Manages special projects and initiatives.

Requires a BA/BS degree in a related field
minimum of 7 years reimbursement experience including performing detailed financial modeling and economic analyses
CPC -Certified Professional Coder strongly preferred
MBA or other equivalent advanced degree strongly preferred
Strong behavioral health background preferred
Strong critical thinking and analytical skills
Understanding of pricing methodologies preferred
Strong written and verbal communications

Provider Reimbursement Manager – Behavioral Health, Coding

Key skills