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Manager of Reimbursement

Omaha, NE
Posted 01/13/23

Job Description

Blue Cross and Blue Shield of Nebraska (BCBSNE) is more than just an insurance company; we exist to be there for people in the best and hardest moments of their lives.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it!

As a member of Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

BCBSNE is happy to offer four work designations for our Omaha area employees: 100% in-office, Hybrid - 3 days in office, Hybrid - 2 days in office, 100% remote. If choosing to work remote, this role can be located in one of the following states: Colorado, Florida, Iowa, Minnesota, Missouri, Nebraska, North Dakota, and Texas.

This position will be responsible for establishing the strategic objectives of the Reimbursement and Claims Edit areas and leading the research, development, implementation and maintenance of payment methodology and payment policies for hospitals, physicians and all other health care professionals. The individual will collaborate with internal teams on efficient processes and claims payment and lead the Reimbursement and Claims Edit teams. This position will also work closely with leadership and the provider contracting area for recommendations on contracting strategies and rate application.

What you'll do:

  • Recommend, set and monitor strategic initiatives for reimbursement and claims edits.
  • Coordinate implementation of provider payment and contracting initiatives.
  • Oversee the assigned focus area of the reimbursement and claims edit teams, assuring timely delivery of department obligations and quality oversight.
  • Serve as a subject matter expert to health delivery engagement, account teams, and provider relations regarding network reimbursement.
  • Manage vendor relationships for payment policy / claims editing and provide oversight to updates.
  • Lead or participate in cross-functional process improvement opportunities and other peer groups.

To be considered for this position, you must have:

  • Bachelor's Degree in Business, Mathematics, Finance, Accounting or Economics and five (7) years of experience within healthcare finance, claims, or management, with focus in healthcare reimbursement.
  • Experience in and understanding of the health care industry, professional and facility reimbursements and billing practices.

 

The strongest candidates for this position will also possess:

  • Masters Degree in Business, Healthcare Administration or other Masters level education

An equivalent combination of education and experience may be substituted for this requirement.

The ability to meet or exceed the attendance and timeliness requirements of their departments.

The ability to work well in a team environment, and be capable of building and maintaining positive relationships with other staff, departments, and customers.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.

Blue Cross and Blue Shield of Nebraska is an Equal Opportunity /Affirmative Action Employer - Minorities/Females/Disabled/Veterans

 

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