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Manager, Facility & Professional Reimbursement
at AmeriHealth New Jersey in New Jersey
AmeriHealth New Jersey provides customized and high-quality health benefits. If you have the skills, the drive and the desire to be the best and work with the best, then, you may be ready to work for AmeriHealth New Jersey.
· Responsible for the development, maintenance and continuous evaluation of AHNJ reimbursement methodologies and related processes for hospitals, ancillary and professional providers.
· Responsible for the development and maintenance of reimbursement systems including but not limited to:
o Standard hospital and ancillary provider fee schedules
o Claims processing logic and policies
o DRG payment systems maintenance
o Maintenance associated with CPT/HCPC coding changes
o Maintenance of provider reimbursement manuals
Responsible for the following reimbursement auditing functions:
o SAS 70 audits
o post MHS rate facility/professional rate load audits
o External audit vendor claim review/coordination
o Facility/professional claims audits with root cause analysis and resolution
· Responsible for managing reimbursement processes and workflow tools associated with the “end to end” contracting process. This includes the maintenance of contracting & reimbursement guardrails, rate exhibit templates, rate load cover sheets, and other tools to ensure contracts terms are loaded correctly and contracts are compliant with company standards.
Assists in the evaluation and analysis of claim payment issues (i.e. under / overpayments) which identify reimbursement issues and/or opportunities. Manages processes associated with the intake and timely resolution of inquiries related to claim payment errors from internaldepartments.
· Coordinates with the Provider Operations Departments to manage requests for claim system enhancements that support reimbursement methodology strategies.
· Coordinates with Claims Payment Policy Department to ensure alignment between reimbursement systems and related policies.
· Serves as a liaison to the Corporate and Financial Investigations Department and ensures that audit findings are incorporated into process improvement and/or methodology changes.
· Provides senior level direction and oversees a staff of one to three reimbursement analysts
· Performs other duties as required
All resumes submitted directly to an AmeriHealth New Jersey employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the AmeriHealth New Jersey Human Resources Department will be deemed the sole property of AmeriHealth New Jersey .
Please note that no fee will be paid in the event the candidate is hired by AmeriHealth New Jersey as a result of the referral or through means other than our established process.
AmeriHealth New Jersey is an Equal Opportunity Employer (EOE). Qualified applicants are considered for employment without regard to age, race, color, religion, sex, national origin, sexual orientation, disability, or veteran status.
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://independencebluecross.contacthr.com/20877837
· Responsible for the development, maintenance and continuous evaluation of AHNJ reimbursement methodologies and related processes for hospitals, ancillary and professional providers.
· Responsible for the development and maintenance of reimbursement systems including but not limited to:
o Standard hospital and ancillary provider fee schedules
o Claims processing logic and policies
o DRG payment systems maintenance
o Maintenance associated with CPT/HCPC coding changes
o Maintenance of provider reimbursement manuals
Responsible for the following reimbursement auditing functions:
o SAS 70 audits
o post MHS rate facility/professional rate load audits
o External audit vendor claim review/coordination
o Facility/professional claims audits with root cause analysis and resolution
· Responsible for managing reimbursement processes and workflow tools associated with the “end to end” contracting process. This includes the maintenance of contracting & reimbursement guardrails, rate exhibit templates, rate load cover sheets, and other tools to ensure contracts terms are loaded correctly and contracts are compliant with company standards.
Assists in the evaluation and analysis of claim payment issues (i.e. under / overpayments) which identify reimbursement issues and/or opportunities. Manages processes associated with the intake and timely resolution of inquiries related to claim payment errors from internaldepartments.
· Coordinates with the Provider Operations Departments to manage requests for claim system enhancements that support reimbursement methodology strategies.
· Coordinates with Claims Payment Policy Department to ensure alignment between reimbursement systems and related policies.
· Serves as a liaison to the Corporate and Financial Investigations Department and ensures that audit findings are incorporated into process improvement and/or methodology changes.
· Provides senior level direction and oversees a staff of one to three reimbursement analysts
· Performs other duties as required
All resumes submitted directly to an AmeriHealth New Jersey employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the AmeriHealth New Jersey Human Resources Department will be deemed the sole property of AmeriHealth New Jersey .
Please note that no fee will be paid in the event the candidate is hired by AmeriHealth New Jersey as a result of the referral or through means other than our established process.
AmeriHealth New Jersey is an Equal Opportunity Employer (EOE). Qualified applicants are considered for employment without regard to age, race, color, religion, sex, national origin, sexual orientation, disability, or veteran status.
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://independencebluecross.contacthr.com/20877837
Published on Aug 12, 2011
Viewed: 217 times
Viewed: 217 times
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