Director of Provider Network Reimbursement en WPS Health Solutions

Role Snapshot

Our Director of Provider Network Reimbursement serves as a key resource to Health Plan leadership for providing comprehensive reimbursement support for commercial/ASO, Medicare, and/or Medicaid programs. This role is responsible for advising, managing and optimizing healthcare reimbursement processes. Provide key support in the analysis of reimbursement reporting and ensure compliance with regulations while maximizing financial performance for healthcare providers. This Director will have advanced knowledge of government payment regulations, third party reimbursement practices, and have excellent communication and staff management skills. They will promote a positive atmosphere and maintain a high degree of customer service orientation to include proactive interaction with staff and managers.

Salary Range

$170,000 ~ $210,000
The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.

Work Location - Hybrid - 1717 W. Broadway in Madison, WI
Our first consideration will be to have this new employee live in the state of Wisconsin to take advantage of Hybrid work and collaboration. Employees living within 45 miles of WPS Headquarters (1717 W. Broadway in Madison, WI) will be expected to be able to be able to work Hybrid 2 days a week on a regular basis.

How do I know this opportunity is right for me?  If you:

• Can drive the collection, validation, analysis and effective use of provider transparency rules throughout the organization to help drive increased use of data to effectively position the organization competitively in the market.
• Have developed and led financial arrangements and opportunities for all providers in expansion markets ensuring competitive positioning for contract rates structures.
• Enjoy recommending strategic development to Network Solutions team and others in the creation of value-based models; drives research and analysis to determine the best approaches. 
• Can develop and lead the implementation of new payment methodologies to ensure leading edge performance for all product segments.
• Work to support contract modeling team and consistently evaluate ensure an effective contract modeling process where needed upgrading the tools and processes in conjunction with the contract modeling team.
• Like to provide data and information to negotiate provider reimbursement rates; includes modeling of current provider arrangements and reimbursement policies.
• Can tracked progress for all fee-for-service and non-fee-for-service contracts relative to expectations and identify areas of variance and opportunity.
• Like to develop financial measures and clinical opportunity reporting for all providers.
• Enjoy Alternative Contract Financial Monitoring: and can lead financial analysis and recommendations regarding alternative reimbursement activities; drives research and analysis to determine the best approaches
• Want to lead the research, analysis and implementation of innovative reimbursement programs, including bundled payments.
• Like to partner with leadership to identify and implement innovative contracting reimbursement strategies.
• Have led an Independent Dispute Resolution (IDR) program, ensuring continuous compliance with evolving federal guidance related to the No Surprises Act and Qualified Payment Amount (QPA) calculations.
• Enjoy managing key relationships with external partners and regulators, drives business decisions through the analysis of financial and operational IDR data, and reports on key performance metrics to senior leadership.
• Can drive process improvements to enhance workflow efficiency.
• Are able to establish and maintain mutually beneficial provider and vendor relationships.
• Like to provide leadership, coaching, and skill development for Provider Analytics and Reimbursement team; ensures that staff has appropriate analytic tools to effectively accomplish assigned responsibilities.

Minimum Qualifications

• Bachelor's degree in healthcare administration, business management or a relevant field, or equivalent work/educational experience.
• 10 or more years of health plan work experience.
• 7 or more years of progressive leadership experience managing relevant health plan provider reimbursement.
• In depth understanding of healthcare reimbursement, Government reimbursement and familiarity with healthcare billing and coding practices and technologies.
• Strong analytical and problem-solving skills with an emphasis on using data to drive operational and financial performance including value-based arrangement experience including alternative payment arrangements.
• In depth understanding of relevant healthcare federal and state regulations and requirements.
• Exceptional leadership and team-building capabilities.
• Excellent interpersonal and communication skills with the ability to influence at all levels of the organization.
• Ability to identify, prioritize and drive work efforts with the highest returns on investment to achieve desired health plan goals.
• Ability to work in a complex, rapidly evolving and deadline-driven environment with multiple internal and external stakeholders.
• Working knowledge of the challenges facing health plans and the broader healthcare industry.

Preferred Qualifications

• 10 or more years of progressive leadership experience managing relevant health plan provider reimbursement and Government reimbursement functions.
• Experience navigating Wisconsin Health plan markets and provider networks.
• Prior experience with WPS systems and processes.

 Remote Work Requirements

• High speed cable or fiber internet
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
• Please review Remote Worker FAQs for additional information

Benefits

• Remote and hybrid work options available
• Performance bonus and/or merit increase opportunities
• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Professional and Leadership Development Programs
•  Review additional benefits: (https://www.wpshealthsolutions.com/careers/fulltime_benefits.shtml)

Who We Are

WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.

Culture Drives Our Success

WPS’ culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce—both current and future—to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.

We are proud of the recognition we have received from local and national organization regarding our culture and workplace:  WPS Newsroom - Awards and Recognition.

Sign up for Job Alerts

FOLLOW US!

Instagram
LinkedIn
Facebook
WPS Health Blog