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Medica · 15 hours ago

Manager of Provider Reimbursement

Omaha, NE

Full-time

Hybrid

Mid, Senior Level

$100K/yr - $150K/yr

5+ years exp

Medica is a nonprofit health plan serving over a million members across multiple states. The Manager of Provider Reimbursement will lead fee schedule development and contract modeling processes, ensuring high-quality results while collaborating with various stakeholders to improve efficiency and accuracy.

Health CareMedical

No H1B

Responsibilities

Provides fee schedule development and implementation including uploading new fee schedules, tracking fee schedule activity, and facilitating fee schedule provider renewal impacts and coding updates

Documents processes, dependencies, and tools to maintain fee schedules in Medica’s provider reimbursement payment platforms

Works with stakeholders to refine methods and processes in the development and implementation of provider fee schedules management

Supports provider contract modeling solutions and contract modeling inputs including but not limited to Data Pac inputs

Works together with key stakeholders to optimize Medica’s provider negotiation model process through the promotion of refinements to improve model functionality, efficiency, and accuracy

Promotes and leads efforts focused on data stewardship and best practices

Interacts heavily with other departments in a leadership role. Builds strong relationships with groups across the organization: including: Network Management, Provider Network Operations, and IT

Training and mentoring of team members

Provides support to network management strategic initiatives

Assists with other provider finance activities such as supporting Medical Expense Committee, Reimbursement Committee, & commercial RFPs