Director Provider Reimbursement

Profile

Description

The Director, Provider Reimbursement is responsible for the leadership, strategy development and execution of Humana Military's provider reimbursement methodologies. This leader is responsible for timely and accurate implementation of Government supplied or directed fee schedules, proprietary fee schedules, prospective payment system software, and provider-specific reimbursement factors used by the TRICARE claims system. This leader will also be accountable for advancing and implementing alternative payment methodologies through collaboration with vendors and other departments within the organization to include Network Operations, Provider Administration, Claims, and IT.

The individual in this role will be accountable for leading a highly efficient and engaged team of associates.

Responsibilities

The Director, Provider Reimbursement develops and executes strategies to ensure all fee schedules, Pricers, and provider-specific reimbursement factors are implemented timely and accurately. Strategies shall include the development of reimbursement policy and processes and surveillance techniques to ensure compliance with government regulations.

In collaboration with other leaders, this Director will develop and execute strategies to maximize discount and trend incentives through the implementation of alternative payment methodologies. They will also establish and manage goals, priorities, staffing, and budgets for the Program Reimbursement Team.

The Director needs to develop and maintain strong collaborative business relationships with leaders across the Humana Military organization and Defense Health Agency and ensure all TRICARE directives are responded to as required.

Our Government Contract Requires US Citizenship for this Position.

Required Qualifications

Bachelor's Degree

8 or more years of healthcare experience

Strong understanding and experience with provider reimbursement and fee schedules

Sees ahead clearly and is future oriented; anticipates future consequences and trends accurately

Proven ability to establish and maintain strong professional, collaborative relationships

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Desired Qualifications

Tricare reimbursement experience

Experience with value-based care and alternative payment models

Additional Information

This role is open to all locations in the continental United States.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com