Manager Contract Compliance And Payment Variance

Highmark Health

Base: $50.88 - $83.84 ph; bonus/equity: not specif...
Managed care reporting and underpayment analysis
Contract negotiation and sca administration
Payor policy interpretation and reimbursement modeling
This role supports the Managed Care Department in contract negotiations, compliance, and reimbursement analysis while collaborating with key stakeholders on payor policies

Job Summary

  • This role supports the Managed Care Department in contract negotiations, compliance, and reimbursement analysis while collaborating with key stakeholders on payor policies.
  • The incumbent manages all aspects of Managed Care related reporting including underpayments, reimbursement analysis, and modeling for contract performance.
  • Employees must adhere to HIPAA regulations and company ethical standards regarding the protection of confidential customer information.

Matching Summary

This role supports the Managed Care Department in contract negotiations, compliance, and reimbursement analysis while collaborating with key stakeholders on payor policies.

Salary

Base: $50.88 - $83.84 per hour; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Must-have

  • Managed Care reporting and underpayment analysis
  • Contract negotiation and SCA administration
  • Payor policy interpretation and reimbursement modeling
  • Staff hiring, coaching, and performance management
  • Contract management system maintenance

Nice-to-have

  • Strong critical thinking and problem-solving skills
  • Process improvement for accuracy and efficiencies
  • Reliable customer service and communication skills

Key Requirements

  • Minimum Bachelor's degree in Finance, Business, or Healthcare Administration
  • 5 years in Health Care Provider or Insurance experience
  • 5 years in Financial Analysis experience
  • 3 years in Healthcare Reimbursement experience
  • 1 year in Leadership or Management experience

Work Rights

Not specified

Tailored Resume

Cover Letter