Manager, Reimbursement Policy

At Medica, we believe our success starts and ends with our employees— and their dreams for the future.  We are a dynamic and growing health plan provider based in Minnetonka, MN and we are proud to serve more than 10,000 employers and over one million members throughout the Upper Midwest.  That’s why we are so committed to a workforce that reflects the strength and diversity of the communities we serve. Around here, you will find a genuine dedication to delivering the best we can, as we strive to become the community’s health plan of choice.
 
Medica offers a great work environment, an attractive salary and benefits package, employee wellness and training programs, on-site cafeteria, free fitness center, and miles of walking trails.EEO/AA

 
The Manager, Reimbursement Policy is responsible for financial analysis across a broad spectrum of issues related to provider analysis. Lead Medica's Reimbursement Policy Committee (RPC), Subcommittee, and Facility Policy workgroup. Make certain all policies, both Medica's and those shared with UHG are updated and implemented, if appropriate, in a timely manner. Manage coding specialist positions as assigned to support the reimbursement initiatives of Medica. Participate as a member of MTAC and BIC committees, so as to be apprised and able to manage research and implementation needs that may come to the RPC and related committees from these groups. Direct research of coding and reimbursement standards, both national and local, for use in benchmarking and comparison with Medica's policies and ways of doing business. Be able to quantify research into recommendations for the RPC review and approval. Serve as a resource to the Network Management department for complex contract negotiations. Provide analysis and recommendations in support of managerial decisions related to reimbursement policy and claims payment processes. Provide leadership, guidance and technical training to direct reports. Work effectively with all levels of management. Complete all other projects as assigned. This person will work extensively with all levels of staff from ranging from administrative staff the Vice President. This role interacts with almost all areas of Medica, including (but not limited to) Network Management, Sales, Finance, Legal, Communications, and Operations. In addition, this role works with external consultants as well as UHG reimbursement resources.

Bachelor's degree or equivalent experience within coding and healthcare field; knowledge of reimbursement methodologies and industry approaches. Detailed knowledge of claims systems and related claims payment methodologies a plus. 7+ years of relevant work experience required. Management experience a plus. Excellent problem solving, technical and analytical skills; ability to analyze, coordinate and document complex financial data, claims detail, correct coding methods. Ability to provide leadership, coaching and direction to highly skilled professional/ technical staff. Excellent interpersonal skills; ability to work with all levels of management on a variety of issues and/or projects. Demonstrated ability to apply knowledge to the development
of contracting strategies and reimbursement policy.