Physician Reimbursement Integrity Manager

Job Posting Description

This role will work closely with the Director Physician Services Pricing & Analytics on strategic projects to transform and continuously improve all aspects of the Physician Reimbursement Integrity function for the Physician's Organization (PO) at Boston Children's Hospital.
This Physician Reimbursement Integrity Manager will:

• Analyze PO managed care contracts and identify operational and payment issues. Develop and document proposed pricing strategy recommendations.
• Monitor and value impact of Payer's payment policies and provide guidance to adjust contracting reimbursement to preserve revenue neutrality principles.
• Implement the managed care contracts into EPIC and Experian.
• Track changes in Payer rates, requirements and applicable regulation and the impact on charges and requirements for procedures.
• Generate in depth analytics and reporting on Single Case Agreements (SACs) to ensure proper reimbursement on targeted accounts.
• Monitor and value impact of Payer's payment policies and provide guidance to adjust contracting reimbursement to preserve revenue neutrality principles.
• Monitor, interpret and report on changes in performance, market trends, health care delivery systems and legislative initiatives, which impact managed care efforts.
• Track changes in Payer rates, requirements and applicable regulation and the impact on charges and requirements for procedures.
• Provide guidance to the PO Contracting Committee, medical staff and Enterprise Analytics to implement the Enterprise Managed Care strategy.
• Complete the PO's Charge Master Annual Update, including pricing of newly requested CPT codes.
• Track, report, follow up on and distributes BCH funds transfers to PO resulting from BCH only Agreements and SCAs.
• Hires and trains staff as needed.

To qualify, you must have:

• BA degree in Health Care Administration, Finance or a closely related field plus at least 5 years of relevant experience.
• Comprehensive analytical skills necessary to anticipate, design, or enhance highly complex financial models and PO/hospital-wide systems and programs.
• Ability to resolve problems requiring a comprehensive and state-of-the-art awareness of the technology and literature in a professional, technical or scientific field.
• Ability to develop financial and operating models/plans for large hospital divisions.
• In-depth knowledge of reimbursement regulations for Medicare, Medicaid and Managed Care.
• Ability to successfully perform revenue and reimbursement capture, be highly analytical, detailed and independent.
• Proven collaborative skills to persuade and negotiate with peer level managers on issues and programs that impact the PO.
• Ability to effectively deal with conflicting views or issues and mediate fair and workable solutions.
• Excellent oral, written, and interpersonal communication skills.

Boston Children's Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.
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