Director of Reimbursement and Managed Care

1 week ago


Waterville, Maine, United States MaineGeneral Health Full time
Job Summary:

MaineGeneral Health is a leading healthcare system that values excellence, compassion, and collaboration in providing exceptional patient care.

We are seeking a highly skilled finance professional to serve as the Director of Reimbursement and Managed Care, overseeing all aspects of reimbursement, managed care contracts, and payer enrollment.

The ideal candidate will possess a deep understanding of healthcare finance, regulatory requirements, and a proven track record in a similar role.

They will also have a strong work ethic, intuitive problem-solving skills, and the ability to meet evolving organizational needs.

The Work:
  1. Manage and oversee the Charge Description Master (CDM) rate setting
  2. Lead contract negotiations and manage payer relationships
  3. Utilize Sorian and StrataJazz contracting modules
  4. Perform contract modeling and troubleshoot payer issues
  5. Oversee contract management and reporting
  6. Ensure compliance with price transparency regulations
  7. Support the revenue budget process, including revenue/statistical variance analysis
  8. Prepare monthly and ad-hoc net revenue reporting
  9. Assist in service line analysis with FP&A
  10. Oversee cost reporting for most companies and conduct regulatory research
  11. Analyze government reimbursement and assist with provider and payer enrollment
  12. Manage professional enrollment, facility credentialing and re-credentialing, including CAQH processes
  13. Lead PHO contract negotiations and planning
You Have:
  • Bachelor's degree in Finance, Accounting, Business Administration, or related field (Master's preferred)
  • Minimum of 7 years of experience in healthcare reimbursement and managed care – some leadership experience is preferred
  • Extensive knowledge of healthcare finance, reimbursement methodologies, and regulatory requirements
  • Experience with Soarian, StrataJazz, and other relevant software systems preferred
  • Strong analytical, problem-solving, and decision-making skills
  • Excellent communication and negotiation abilities
  • Demonstrated ability to lead and manage a team effectively
Benefits:

MaineGeneral Health offers a comprehensive benefits package to support the well-being of its employees, including quality health, dental, and vision benefits, wellness programs, and resources to promote a healthy lifestyle.

Employees also have access to a generous earned time plan, employee assistance program, and tuition reimbursement opportunities.

Additionally, MaineGeneral Health offers a 403(b) company-matching contributions and 401(a) retirement income plan to support employees' financial well-being.

The company is an equal opportunity employer and is committed to diversity, equity, and inclusion in the workplace.



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