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Coordinates Medicare and Medicaid enrollment/re-enrollment and ma...

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Mansueto Ventures is home to two of the most iconic and vibrant brands in business publishing: Inc. and Fast Company. Every day, the content, awards, and events produced help entrepreneurs and innovators succeed by providing useful insights, sparking essential conversations, and offering much-needed inspiration.

Inc. is the voice of the American entrepreneur, inspiring and documenting the risk-takers and ultra-driven go-getters who represent the most dynamic force in the American economy.
Fast Company is the world’s leading business media brand, focusing on innovation in technology, leadership, and design to inspire readers to shape the future of business.

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Summary:

The Associate Director ensures accurate and appropriate government payor reimbursement-related calculations and estimates and ensures UTMB compliance with Medicare and Medicaid regulations.

Scope: Institutional

Responsibilities:

Responsible for technical aspects, calculations and analyses of multiple areas of Medicare and Medicaid reimbursement components including, but not limited to, cost report preparation, audits, re-openings, appeals, IME, DGME, DSH, UC, Organ Acquisition, Bad Debt, Wage Index, Physician Time Studies, Paramedical Education Time studies and Provider Enrollment, and directs departmental employees in these areas.
Ensures accuracy of Medicare, Medicaid and TDCJ cost report tentative and final settlements, communicates problems to Medicare and Medicaid contractors and directs departmental employees in handling related issues.
Directs preparation and ensures accuracy of monthly Medicare, Medicaid and TDCJ settlement account estimates and directs preparation of related third-party audit support.
Manages external audits, resolves audit issues and responds to inquiries from external auditors, such as Medicare, Medicaid, State and OIG auditors.
Responsible for state/Medicaid supplemental payment applications and audits and for directing staff in preparation of these reports.
Supports Director, Finance-Government Reimbursement in preparing annual Medicare, Medicaid and TDCJ net revenue budget rates.
Represents the Government Reimbursement department on various committees and task force groups.
Maintains current knowledge of Medicare reimbursement and cost reporting regulations, keeping abreast of recent changes that may affect the department’s policies and procedures, and takes necessary actions to implement appropriate processes and procedures to ensure compliance with Medicare and Medicaid regulations.
Supports Director, Finance-Government Reimbursement in preparing and monitoring departmental budget.
Participates in recruitment, hiring, orientation, training, supervision, evaluation, disciplinary action and/or termination process, as needed, within department.
Performs related duties as assigned.

Minimum Qualifications:

Bachelor's degree in accounting, business or related field plus eight (8) years of Medicare and Medicaid reimbursement experience to include four (4) years of reimbursement supervisory experience.

Preferred Qualifications:

Master's degree in accounting, CPA or business plus eight (8) years of Medicare and Medicaid reimbursement experience to include four (4) years of reimbursement experience at manager level or above.
Experience with Medicare IME, DGME, DSH and Organ Acquisition reimbursement and experience with Texas Medicaid and state supplemental payment methods.

Equal Employment Opportunity

UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.

","

Summary:

The Associate Director ensures accurate and appropriate government payor reimbursement-related calculations...","Associate Director of Finance - Government Reimbursement","Full Time",[529],{"_457":458,"_453":530,"_451":531,"_455":456},"Galveston","Galveston, TX, United States",["B","2246405866"],"Work at UTMB Health","5 months ago","/jobs/2246405866-associate-director-of-finance-government-reimbursement","/jobs?keyword=UTMB+Health","/jobs?location=Galveston%2C+TX%2C+United+States","/jobs?keyword=Associate+Director+of+Finance+-+Government+Reimbursement",{"_435":434,"_439":540,"_469":470,"_461":541,"_248":542,"_446":543,"_433":434,"_113":544,"_437":199,"_438":199,"_471":470,"_447":199,"_448":545,"_431":551,"_472":552,"_436":120,"_487":553,"_477":554,"_489":544,"_490":555,"_492":556,"_494":557,"_496":558},["D",1773914400000],"Compunnel, Inc.","A healthcare services company is seeking an Enrollment Coordinator in Cumberland, RI. This role supports behavioral health provider enrollment activities, ensures proper enrollment with government and commercial payers, and requires full-time on-site attendance due to physical mail handling. Ideal candidates are detail-oriented, organized, and skilled in managing multiple tasks while communicating effectively with providers and internal teams. Qualifications include a high school diploma or equivalent, reliability, and experience in government payers such as Medicare and Medicaid.\n#J-18808-Ljbffr\n","A healthcare services company is seeking an Enrollment Coordinator in Cumberland, RI. This role supports behavioral health provider enrollment acti...","On-Site Healthcare Enrollment Specialist",[546],{"_457":458,"_453":547,"_451":548,"_455":549,"_459":550},"Cumberland","Cumberland, RI, United States, 02864","RI","02864",["B","2933294023"],"Work at Compunnel, Inc.","3 days ago","/jobs/2933294023-on-site-healthcare-enrollment-specialist","Cumberland, RI, United States","/jobs?keyword=Compunnel%2C+Inc.","/jobs?location=Cumberland%2C+RI%2C+United+States","/jobs?keyword=On-Site+Healthcare+Enrollment+Specialist",{"_435":434,"_439":560,"_469":470,"_461":561,"_248":562,"_446":563,"_433":434,"_113":564,"_437":199,"_438":199,"_471":470,"_447":199,"_448":565,"_431":571,"_472":572,"_436":120,"_487":573,"_477":574,"_489":564,"_490":575,"_492":576,"_494":577,"_496":578},["D",1773079200000],"D4C Dental","The

Provider Enrollment

Specialist will be responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process.\nLiaise between the practitioners, health plans, hospitals, patient care facilities and all related entities regarding credentialing, malpractice coverage, and practitioner enrollment.\nManage credentialing and re-credentialing processes along with completing applications for respective Commercial and Medicaid dental plans; contacting doctors for additional documentation if required; monitoring applications for timely approval and follow-up as needed.\nManagement of CAQH applications including completion and updates. Maintains provider information in online credentialing databases and systems.\nResponsible for all necessary updates including, but not limited to address changes, NPI updates, etc.\nEnsures facility addresses, provider information is current with health plans, agencies and other entities.\nCoordinate, compile, and prepare reports pertaining to doctors as requested. Preparation of correspondence associated with the credentialing process.\nMaintains knowledge of current health plans and agencies requirements for credentialing doctors.\nTracks license and certification expirations for all practitioners to ensure timely renewals. Follow-up with practitioners regarding expiring documents to ensure compliance.\nPerforms other duties as assigned.\nEducation and Experience:\nHigh school diploma; Bachelor's degree preferred.\n2-3 years experience in Managed Care credentialing and Medicaid enrollment.\nExperience with integrating dental practices and acquisitions.\nNAMMS Certifications is a plus.\nWe take care of our valued employees by offering:\nPaid Time Off\nPaid Holidays\nMedical, Dental and Vision benefits\nHealth Savings Account, Flex Spending\n401K\nShort and Long Term Disability Insurance\nLife Insurance\nOpportunities for Community Service\nAbout D4C Dental Brands\nWork that Matters

At D4C Dental Brands, team members are positioned to make a difference in the lives of patients. As the leading and fastest growing support organization for specialty dental practices, we are able to enhance and advance the overall patient experience. Our success comes from our focus on supporting high quality patient care and our shared vision of \"Raising the Standard in children's oral health.\" If you're ready to make a difference in the lives of children - and to positively impact the healthcare system at large - there's no better place to make this happen. We believe that when committed teams come together with dedicated expert dentists for the purpose of helping children achieve a lifetime of great oral health, the results are tremendous. This shared commitment is the foundation to everything we do.\n","The

Provider Enrollment

Specialist will be responsible for leading, coordinating, monitoring, and maintaining the credentialing a...","Provider Enrollment Specialist",[566],{"_457":458,"_453":567,"_451":568,"_455":569,"_459":570},"Atlanta","Atlanta, GA, United States, 30383","GA","30383",["B","2833046112"],"Work at D4C Dental","13 days ago","/jobs/2833046112-provider-enrollment-specialist","Atlanta, GA, United States","/jobs?keyword=D4C+Dental","/jobs?location=Atlanta%2C+GA%2C+United+States","/jobs?keyword=Provider+Enrollment+Specialist",{"_435":434,"_439":580,"_469":470,"_461":581,"_248":582,"_446":583,"_433":434,"_113":584,"_437":199,"_438":199,"_471":470,"_447":199,"_448":585,"_431":591,"_472":592,"_436":120,"_487":593,"_477":594,"_489":584,"_490":595,"_492":596,"_494":597,"_496":598},["D",1774184400000],"Conduit Health, Inc","A healthcare technology company is seeking a Provider Enrollment Associate to manage a high volume of applications across Medicaid, Medicare, and commercial plans. The ideal candidate is highly organized, detail-oriented, and thrives in a fast-paced environment. This role offers a competitive salary, remote work flexibility, and unlimited PTO. Previous experience in healthcare administration or compliance is a plus. Join a venture-backed company and help drive operational efficiency as we scale rapidly.\n#J-18808-Ljbffr\n","A healthcare technology company is seeking a Provider Enrollment Associate to manage a high volume of applications across Medicaid, Medicare, and c...","Provider Enrollment Specialist — Remote, High-Impact",[586],{"_457":458,"_453":587,"_451":588,"_455":589,"_459":590},"New York","New York, NY, United States, 10261","NY","10261",["B","2973388884"],"Work at Conduit Health, Inc","18 hours ago","/jobs/2973388884-provider-enrollment-specialist-remote-high-impact","New York, NY, United States","/jobs?keyword=Conduit+Health%2C+Inc","/jobs?location=New+York%2C+NY%2C+United+States","/jobs?keyword=Provider+Enrollment+Specialist+%E2%80%94+Remote%2C+High-Impact",{"_435":434,"_439":600,"_469":470,"_461":601,"_248":602,"_446":603,"_433":434,"_113":604,"_437":199,"_438":199,"_471":470,"_447":199,"_448":605,"_431":610,"_472":611,"_436":120,"_487":612,"_477":613,"_489":604,"_490":608,"_492":614,"_494":615,"_496":616},["D",1772744400000],"HealthPartners","Job Description

HealthPartners is hiring a Contract Provider Relations Consultant. They manage HealthPartners Medicare and Medicaid provider network and provider reimbursement approach.

Overall responsibilities include:\nEstablish and maintain positive contractual and strategic relationships between HealthPartners and its network of providers, focused on those providers who deliver services exclusively for the Medicare and Medicaid population.\nDevelop and implement network contracting strategies consistent with HealthPartners overall objectives for Medicare and Medicaid specific covered services.\nPerform project management duties for initiatives designed to enhance strategic contracted partnerships and services for Medicare and Medicaid members\nWork with government programs management to ensure compliance with Medicare product requirements and regulations\nMaintain HealthPartners Medicare and Medicaid fee schedules and ensuring alignment with DHS and CMS published IP, OP, professional, & ancillary fee schedules. Perform annual fee schedule increase analysis for budgeting\nDevelop and implement sound reimbursement methodologies and value-based contracts that incentivize providers to manage the cost and quality of Medicare and Medicaid members.\nNegotiate contract terms with providers\nManage the day-to-day operational needs related to providers.\nSupervise and mentor direct reports, including service specialists and contract consultants when applicable.\nInvestigate, mediate and resolve inquiries regarding the delivery of care by providers.\nProvide support to the Quality Utilization Management Department in analyzing provider trends and developing action plans to effect change\nResponsible for the supervision of staff, including having the authority to hire, transfer, lay off, promote, discipline and discharge, train, reward and review performance of employees. Ensures compliance to organizational and departmental policies and procedures.\nACCOUNTABILITIES:\nManage provider network strategies for HealthPartners Medicare and Medicaid network, aligning with HealthPartners' service area, product and financial goals. Regularly attend internal Medicaid and Medicare strategic meetings providing input on strategic decisions related to Medicare and Medicaid service lines.\nIndependently manage and supervise the administrative functions relating to contracted providers who provide services exclusively to Medicare or Medicaid members; including network strategy development, financial analysis, negotiations, contract drafting, contract monitoring, establishing provider relations and communications.\nIndependently manage and supervise the implementation of provider contracts with providers who exclusively see Medicare or Medicaid members. Develop systems, policies and procedures to communicate and ensure the successful implementation of contracts by the following internal departments: Claims, Accounts Payable, Member Services, Clinic Operations, Support Services, Quality Utilization Management, Referral Secretaries, Government Service, Pharmacy Care Network, Sales and Marketing, and Contracting.\nIndependently manage and supervise contract maintenance and contract filing functions. Develop and maintain systems and procedures to ensure the collection of credentialing or other oversight provider information. Ensure the contents and filing of contracts and amendments are in accordance with the Minnesota Department of Health, government programs, accreditation and other regulatory agency requirements. Ensure the maintenance of current provider listings for internal uses and to ensure that contracts are current and up to date with all necessary or required contract provisions.\nMonitor contract compliance and adherence to contract provisions by providers and HealthPartners for providers who exclusively see Medicare or Medicaid members. Monitor the payment of claims by HealthPartners to ensure the correct application of contract payment terms. Take corrective action with providers who are not complying with contract terms, or with HealthPartners departments not adhering to contract agreements. Participate in year end contact settlement process, where appropriate.\nDevelop and implement appropriate Medicare and Medicaid reimbursement methodologies such as capitation, case rates, fee schedules, per diems, Ambulatory Patient Classifications, Diagnostic Related Groups, and value-based contracts.\nMonitor, analyze and interpret financial and utilization patterns of Medicare and Medicaid providers. Implement corrective action steps as necessary.\nManage the operational, financial and administrative relationships with providers. Provide support to the Medical Director, Associate Medical Directors and Department Heads to coordinate communications and operations.\nParticipate in annual planning exercise for Medicare and Medicaid lines of business\nProvide project management for a variety of strategic development projects for Medicare and Medicaid lines of business. Develop project plans and approaches for problem solving; assist executive leadership in determining major deliverables and identifying project participants. Determine responsibilities, establish project time lines, define checkpoints, and determine appropriate structures for relationships. Lead implementation of project plans.

REQUIRED QUALIFICATIONS:

Bachelor's degree in health care administration, business administration or other relevant field.\nMinimum of seven years experience working in the health care industry with three years working in a provider relations/provider administrative role.\nPrevious experience in a management position, independently responsible for planning and development of a key company function.\nStrong analytical and financial modeling skills.\nAbility to develop and evaluate contracting strategies.\nStrong oral and written skills with the ability to make effective group presentations and consensus building.\nExcellent team leadership skills with a sound level of interpersonal effectiveness.\nAbility to work independently, making independent decisions as they relate to the successful relationships with providers, consistent with HealthPartners goals.\nPREFERRED QUALIFICATIONS:

Strong financial and systems background.\nPrevious experience in Medicare and Medicaid provider contract negotiations\nPrevious experience in health care industry with Medicare and Medicaid lines of business\nAn additional two years experience in network development in specific products, e.g. workers compensation.\nMAJOR CHALLENGES:

Establishing a successful working relationship with provider's professional staff, legal counsel and/or board members. This requires independent decision-making and strong negotiating skills with a constructive approach toward problem resolution.

Manage the administrative requirements of HealthPartners for all products offered.

DIMENSION:

Actively participate in creating and managing a successful provider networks serving approximately 600,000+ HealthPartners members with revenues of approximately $2.0 billion.\nActively responsible for managing contract costs within the departments operating budget.\nDirectly supervise direct reports, including service specialists and contract consultants, when applicable.

About Us

At HealthPartners we believe in the power of good - good deeds and good people working together. As part of our team, you'll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.

We're a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.

At HealthPartners, everyone is welcome, included and valued. We're working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.

Benefits Designed to Support Your Total Health As a HealthPartners colleague, we're committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.

Join us in our mission to improve the health and well-being of our patients, members, and communities.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.\n","Job Description

HealthPartners is hiring a Contract Provider Relations Consultant. They manage HealthPartners Medicare and Medicaid provid...","Medicaid and Medicare Provider Relations Consultant",[606],{"_457":458,"_453":607,"_451":608,"_455":609},"Bloomington","Bloomington, MN, United States","MN",["B","2791329156"],"Work at HealthPartners","17 days ago","/jobs/2791329156-medicaid-and-medicare-provider-relations-consultant","/jobs?keyword=HealthPartners","/jobs?location=Bloomington%2C+MN%2C+United+States","/jobs?keyword=Medicaid+and+Medicare+Provider+Relations+Consultant","actionData","errors"]