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Payment Intent Policy Manager

Company: Medica
Location: Minnetonka
Posted on: March 26, 2020

Job Description:

The Payment Intent Policy Manager is responsible for the overall strategic and tactical activities related to identifying, developing, implementing and supporting Medica's provider reimbursement policies.--The Payment Intent Policy Manager performs critical functions to manage the end-to-end policy process which include: research, data analysis, policy development, implementation, communication, training, and issue resolution. By evaluating current and changing industry recognized reimbursement methodologies the Payment Intent Policy Manager ensures consistent, accurate reimbursement to providers.--The Payment Intent Policy Manager serves the critical function of delivering to Medica's customers solidly sourced reimbursement policy based upon recognized industry standard sources (i.e. CMS, AMA, CPT, national and community payers) to ensure payment methodologies are defensible and consistent with Medica's reimbursement philosophy.----The Payment Intent Policy Manager works with the Manager of Payment Intent, Sr. Director Internal Audit, co-chairs of the Reimbursement Policy & Strategy Committee, and other Medica leaders to identify, assess, recommend and implement reimbursement strategies and process improvements.----The Payment Intent Policy Manager performs audits and analyzes coding and claims data to ensure payment outcomes are executed on multiple claims platforms.--Additional Responsibilities:Provides guidance and develops educational tools to meet the needs of internal and external key stakeholders.Facilitates and provides guidance to interdepartmental workgroups based on policy strategies and collaborates on broad Medica initiatives requiring expertise in provider reimbursement methodologies.--Serves as a reimbursement policy subject matter expert on various internal committees and as the Medica representative to external state committees working to standardize administrative transactions for providers and payers focused on reducing health care costs.----QualificationsBachelor's degree preferred. Strong coding experience may be considered in lieu of a Bachelor's degreeHealth Information Management or Nursing with coding/reimbursement experience7+ years of work experience beyond degree3+ years experience related to professional billing and health care reimbursement methodologiesKnowledge of CPT, HCPCS, and ICD 10 diagnosis codes and coding principlesCoding certification (CPC, CPC-P, CPC-H, CCS or CCS-P) or the completion of such certification within one year of employment is required.Experience with hospital/facilities coding (UB-04), revenue codes, DRGs, APCs and ICD 10 diagnosis and procedural codes desirable; those having at least one of the 3+ years of experience in both professional and facilities coding is a plus.RN/LPN nursing degree/experience desirableHMO and claims experience helpful--Skills & AbilitiesStrong understanding and knowledge of coding and reimbursement methodologyFunction as a SME for reimbursement policiesAble to analyze and translate data (to determine financial impact) and develop recommendationsStrong technical writing and verbal communication skillsAbility to prepare and develop and diverse information into effective presentationsStrong computer software skills: Microsoft Office Suite including Access, Excel, PowerPoint, Visio, and WordStrong internet research skillsPossess excellent time management and prioritization skills in order to meet multiple deadlines; comfortable working in a high-paced environmentExperience leading/facilitating process improvement teamsCollaborative problem solving skills to identify and implement effective solutions

Keywords: Medica, Minnetonka , Payment Intent Policy Manager, Executive , Minnetonka, Minnesota

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