Senior Manager, Provider Reimbursements

Employment Type

Full-time

Exempt or Non-Exempt

Exempt

Job Summary

**Hybrid Work Environment - Must reside on Oahu **

Pay Range: $86,500 to $179,500, position is eligible for an incentive bonus

Note: Individuals typically begin between the minimum to middle of the pay range

Provide supervision and development of the Provider Reimbursements Department staff. Develop, manage, and implement HMSA Provider Reimbursement methodologies to ensure corporate strategies and initiatives are achieved. Implement changes to improve and simplify operations throughout HMSA to improve all Provider experiences with HMSA. Envisions and develops fundamental concepts of highly abstract relationships, principles, practices; responsible for program assessment, initiation, planning, and execution to achieve business objectives.

Minimum Qualifications

• Bachelor's degree and six years related experience in financial reporting and/or data analysis, or equivalent combination of education and experience.
• Two years of supervisory/management experience.
• Effective written and verbal communication skills.
• Demonstrate knowledge in project management, planning, and organization.
  
  
  

Duties And Responsibilities

• Oversee management and staff responsible for implementation and administration of Provider Reimbursement methodologies, including, but not limited to: Institutions, Professionals, and ancillary providers.
• Provide management reports and analysis needed for decision making, physician and institutional contracting, and ensuring adequate provider network access.
• Participate in provider negotiations to ensure that costs are within the anticipated budget.
• Administer operational activities to ensure compliance with par provider contracts
• Serve as department leader on large, corporate-wide projects and programs that affect the organizations long term goals and objectives. Partner with management to determine projects/programs desired outcomes as it relates to corporate strategies.
• Recruit, train, and manage staff spanning across all areas of the entire Finance department. Develop and foster personal growth, learning, and accountability of the staff.
• Has oversight of the department's compliance policies, procedures, and internal controls in accordance with SSAE, CMS, MAR, SOC 2, BCBSA guidelines, and other regulatory requirements.
• Plan, schedule, measure and coordinate projects and tasks for unit and other business areas. Make decisions to control scope and resources, prepare documentation and ensure work flows are in accordance with our par contracts; through use of effective communication skills. Acts as a Lead Representative, presenting HMSA's case externally to the Fee review committee.
• Respond to ad-hoc data requests from management, executive staff, and external departments in relation to corporate goals and initiatives to HMSA's vision. Coordinates Finance duties for Physician fee reviews for all lines of business
• Establish and foster productive working relationships with internal and external parties by:
• Effectively conducting meetings and discussions to achieve collaboration, trust, and consensus
• Achieving service commitments from core and support functional areas
• Prioritizing, tracking, and managing deliverables.
• Assist in monitoring and planning for the department budget. Coordination of all Internal and External audits and implementation of control points for fee loading internally and with partners.
• Perform all other miscellaneous responsibilities and duties as assigned or directed