Manager Provider Reimbursement

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

This position is responsible for the managing of the completion, adjustment, and verification of HMO, PPO, POS and other networks, maintenance of the PREMIER system and knowledge of BlueChip.

Responsible for preparation and delivery of provider settlements and reconciliation of payments and claims. In addition, responsible for the supervision of staff in the handling of provider inquiries concerning the calculation of contractual allowances and for contacting healthcare providers to resolve collection of contractual allowances, and for reconciling differences of contractual allowance balances between Provider Contracts and Financial Reporting.

Job Requirements :

• Bachelor Degree in Finance, Accounting, Computer Science, or Statistical Analysis and 5 years of Medicare audit, hospital accountings, or managed care experience OR 9 years of Medicare audit, hospital accountings, or managed care experience.
• 1 year of management or leadership experience
• 3 years as a primary analyst responsible for running production activities for a designated product and / or system (e.

g., UPP, PPO, POS, HMO, etc.).

• 3 years as primary liaison with providers, internal departmental, and audit inquiries.
• Knowledge of hospital and institutional provider billing, payment methodologies, financial reporting and balancing techniques, acceptable accounting / audit controls, and managed care contracts.
• Knowledge of the health care industry, insurance concepts, claims processing, and provider / membership systems.
• Ability to provide analytical and supervisory guidance to less experienced analysts.
• Ability to identify solutions to complex processes without assistance.
• Analytical, verbal and written communication skills.
• PC proficiency to include Word, Excel, PowerPoint and Outlook.

Preferred Job Requirements :

• Knowledge in Teradata SQL, ie. Enterprise Data Warehouse
• Knowledge of provider reimbursement methodologies for a broad spectrum of professional and provider types and specialties.

i.e. relative value and conversion factor, time and points, modifiers, per unit, and percent of charge.

This is a hybrid role requiring 3 days in the office and 2 days remote

weekly.

We encourage people of all backgrounds and experiences to apply. Even if you don't think you are a perfect fit, apply anyway - you might have qualifications we haven't even thought of yet.

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HCSC Employment Statement :

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.