Manager of Provider Reimbursement

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Manager of Provider Reimbursement leads the management of the fee schedule development, contract modeling, and implementation processes in provider finance. The Manager documents processes, dependencies, and tools to maintain Medica's provider fee schedules and works with stakeholders on identifying refinement opportunities. Additionally, the Manager supports contract model data inputs, stewardship of provider finance data, and works with stakeholders to identify opportunities to improve model functionality, efficiency, and accuracy. The Manager coordinates projects that involve/impact multiple teams and departments. The Manager monitors unit progress toward goals, assists in department planning, and prioritization.

The manager assists in the successful operation of the provider finance department. The incumbent ensures that processes and policies are followed to produce high quality results. The Manager proactively engages in identified opportunities and facilitates solutions with various stakeholders. Performs other duties as assigned.

Key Accountabilities

• Fee Management Schedule
  
  
  
  • Provides fee schedule development and implementation including uploading new fee schedules, tracking fee schedule activity, and facilitating fee schedule provider renewal impacts and coding updates
  • Documents processes, dependencies, and tools to maintain fee schedules in Medica's provider reimbursement payment platforms
  • Works with stakeholders to refine methods and processes in the development and implementation of provider fee schedules management
  
  
  
  

• Contract Model & Data Management
  
  
  
  • Supports provider contract modeling solutions and contract modeling inputs including but not limited to Data Pac inputs
  • Works together with key stakeholders to optimize Medica's provider negotiation model process through the promotion of refinements to improve model functionality, efficiency, and accuracy
  • Promotes and leads efforts focused on data stewardship and best practices
  
  
  
  

• Leadership Activities
  
  
  
  • Interacts heavily with other departments in a leadership role. Builds strong relationships with groups across the organization: including: Network Management, Provider Network Operations, and IT
  • Training and mentoring of team members
  
  
  
  

• Additional Projects
  
  
  
  • Provides support to network management strategic initiatives
  • Assists with other provider finance activities such as supporting Medical Expense Committee, Reimbursement Committee, & commercial RFPs
  
  
  
  

Required Qualifications

• Bachelor's degree or equivalent experience in related field
• 5 years of experience beyond degree

Strongly Preferred Qualifications

• Minimum 4 years of Healthcare Reimbursement experience
• Minimum 4 years of experience working with health care claims data
• Preferred 4 years of Oracle, SAS, and/ or SQL experience

Skills and Abilities

• Professional experience in data and process management
• Knowledge of claims systems and related claims payment methodologies
• Excellent interpersonal skills; ability to work with all levels of management on a variety of financial issues
• Ability to analyze, coordinate, and document numerous projects
• Excellent communication and leadership skills

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, Omaha, NE, or St. Louis, MO.

The full salary grade for this position is $100,300 - $172,000. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $100,300 - $150,465. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.