Job ID 2100049F
Available Openings 1
PURPOSE AND SCOPE:
The Manager of Reimbursement & Payor Relations is responsible for ongoing monitoring, reporting and analysis of regulatory and policy issues pertaining to Spectra's clinical laboratory business. This Manager is responsible for communicating payor policies and guidelines which affect regulatory and reimbursement compliance. The Manager of Reimbursement & Payor Relations acts as a resource for Spectra on reimbursement and regulatory issues impacting Spectra's clinical laboratory business.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Manages, trains and provides guidance to the Reimbursement Analysts within Spectra.
- Researches complex regulatory issues assigned by Senior Director of Reimbursement & Payor Relations to support and assist in the preparation of reports and memoranda on reimbursement issues which impact Spectra's clinical laboratory business.
- Regularly monitors, communicates and educates on payor policy revisions/updates and seek clarification with the payor as necessary,
- Pursues, manages and negotiates managed care contracts with health plans.
- Assists in the preparation of arguments/data required to pursue appeal challenges of Medicare and other third party payer denials.
- Serves as a subject matter expert for Spectra regarding regulatory updates as well as payment, denial and utilization trends.
- Ensures timely submission and renewal of provider enrollments/credentialing for Spectra and manage response to third party audits and legal record requests, including appropriate interaction with legal.
- Creates advanced reports that assist in management's analysis of the impact of regulatory issues on claims payment and test utilization.
- Develops, implements, manages, and refines internal policy & procedures which document departmental processes and efforts to maintain regulatory compliance.
- Provides leadership, coaching and development plans for all direct reports to maintain an engaged and productive workforce; partnering with Human Resources on employee matters.
- Proficient in Reimbursement policy and knowledge of industry practice and business principles. Works on issues of diverse scope where analysis of situation or data requires evaluation of a variety of factors, including an understanding of current business or industry trends.
- Performs other duties as assigned by the Senior Director of Reimbursement, Payor Relations & Contracting to ensure regulatory compliance and support the business interests of Spectra.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Little to no travel is expected for this position.
- This position requires approximately 0% to 5% travel.
- Supervises exempt staff of Reimbursement Analysts
EDUCATION AND REQUIRED CREDENTIALS:
- BA/BS in Business, Accounting or Healthcare related field: Advanced Degree desirable or an equivalent combination of education and experience
EXPERIENCE AND SKILLS:
- 5 - 7 years of experience in relevant healthcare field.
- Superior Understanding of Regulatory & Payment Requirements
- Problem solving & negotiation skills
- 3 – 5 years of supervisory experience
- Knowledge of the laboratory and dialysis industries.
- Strong communication and interpersonal and presentation skills.
- Policy & Internet Research
- Ability to motivate, lead and coordinate team
- Analytic and technical skills (including Excel & Powerpoint)
EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity
Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.
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