Job Description

Our Mission:  Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.

Our Vision: 

Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.

Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!

Position Purpose:

Reporting to the Chief Operating Officer, The Vice President of Reimbursement Services oversees the daily operations and functions of Claims, Provider Data Management, Grievance, Appeals and Disputes, Print and Mailroom.  This position is responsible for the development and execution of Reimbursement Services operational strategies, end-to-end claim process automation, optimization and management, identifying and leveraging technology and data to improve the quality and ensuring compliance with all regulatory and operational requirements. Works collaboratively with all health plan functional areas with the purpose to support the development, implementation, maintenance, monitoring, and continuous improvement of the organization.

Key Responsibilities:

Assure department efficiency and effectiveness:

  • Develop and execute strategic initiatives and programs to enhance existing functions and develop new processes in support of health plan initiatives and requirements
  • Seek opportunities to implement Robotic Process Automation
  • Communicate job expectations to staff, ensure understanding of the expectations and expectations are met or exceeded
  • Plan, assign, monitor, and appraise employee’s job results
  • Ensure staff performance goals are met or exceeded and, if not, appropriate action is taken
  • Maintain, train, orient, mentor and evaluate staff
  • Appropriately train staff production areas, ensure cross-training
  • Develop and implement policies and procedures to ensure appropriate work is completed timely and accurately and maximizes staff productivity; ensure policies and procedures are documented according to organizational protocols; this is inclusive of all training materials
  • Identify, develop and implement opportunities to streamline and improving processes
  • Attend appropriate management meetings to integrate Reimbursement Services into the organization in appropriate and useful ways
  • Set example of proper behavior and accountability to employees and serve as a role model for what is expected of a Health Choice employee
  • Work with other Reimbursement Services management to ensure optimum efficiencies, staffing appropriation and daily operational functions
  • Achieve financial objectives
  • Other duties as assigned

Oversee operations of the Reimbursement Services department:

  • Monitor statistics, production levels and payment and procedural accuracy
  • Ensure Health Choice policies comply with AHCCCS, CMS and other payer policies
  • Evaluate departmental needs and implement necessary controls and interfaces
  • Develop staff in regards to Health Choice, AHCCCS, Medicare, and CMS claims payment guidelines
  • Maximize reimbursements by monitoring internal audit, grievance, appeals and dispute, adjustments and referral statistics
  • Work with Internal Audit on appropriate reporting and follow-up of audit errors

Continue professional growth and development to maintain high quality work:

  • Attend seminars and meeting addressing changes or updates in practices
  • Take necessary steps to stay informed of updates from governing agencies

Education / Experience / Other Requirements

Education:   

  • Bachelor’s Degree in Health Services Administration or related science or administrative field preferred

Years of Experience:  

  • At least 5 years’ experience in medical claims management, preferably in a managed care environment
  • At least 3 years’ supervisory experience
  • At least 3 years in a large healthcare organization

Specialized Knowledge:  

  • Medical Terminology
  • CPT, HCPCS, ASA and ICD-10 coding schemes
  • Claims billing- 1500s, UB92s and dental
  • Managed health plan functions and responsibilities
  • Medicaid and Medicare requirements and procedures
  • Provider contract and fee schedules
  • Plan benefits
  • Encounter submission
  • Ability to logically analyze and solve problems
  • Attention to detail and ability to multi-task
  • Ability to create innovative ideas
  • Ability to establish and maintain good communications with all levels of interpersonal relations
  • Ability to implement and follow through
  • Proficient in Excel and Word applications
  • Claims processing systems
  • Excellent organizational skills
  • Solid organizational skills
  • Proven leadership skills
  • Strong negotiation skills

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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