- Develop, analyze, recommend, and monitor reimbursement and provider strategies; prepare reports that measure the effectiveness of reimbursement and contracting terms and the influence they may have on overall program / plan cost and utilization.
- Analyze data and identify trends, patterns, or other notable issues with an eye for cost reduction opportunities.
- Monitor market trends to identify emerging opportunities or risks in business environments.
- Monitor websites for reimbursement and policy changes for both private and government entities; make recommendations for implementation of these changes.
- Analyze standard plan or provider financial and operational reports in response to customer requirements and business needs
- Lead and implement internal controls; Facilitate definition of data and other information requirements; Define efficient data assembly methods;
and maintain adequate documentation for general reference and audit purposes.
- Create functional summary reports for presentation to management
- Validate and maintain quality and consistency of data and reporting
- On a proactive basis identify and isolate potential problems and work with staff within and outside of the department to develop and implement resolutions;
develop and communicate data adjustments and workarounds.
- Propose resolutions to management to clearly define the increase in value and productivity associated with the changes.
- Annual review of compliance workflows, such as, SSAE, MAR.
- Review provider contracts and ensure that claims system set ups accurately reflect fully executed, signed agreements.
- Participates and promotes team activities by providing leadership, consultation, managing other projects, sharing accountability and expertise, communicating, and improving integrity of workflows, and providing constructive feedback on other team members' performance.
- Perform all other miscellaneous responsibilities and duties as assigned or directed.
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