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Form of work
SalaryThe Director of Medical Economics will oversee strategy, establish policies and procedures, and lead the Medical Economics team through key functions of Alternative Payment Model methodologies, Provider Data, Provider Analysis, and Provider Reimbursement.
This position is eligible to work hybrid. remote or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.
What you’ll do
This position is eligible to work hybrid. remote or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.
Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.
Why Join Us
- Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
- Lead and Inspire: Guide and mentor your team to achieve their full potential and success.
- Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
- Trust: Work for one of the most trusted companies in Kansas
- Flexibility: options to work onsite, hybrid or remote available
- Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire
- Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.
What you’ll do
- Presents recommendations to senior leadership of maximum allowable payments (MAPs) along with quality-based reimbursement program (QBRP) for claims payments - Central to strategic financial planning and impacts overall organizational spending.
- Directs the methodology of strategic pricing and negotiations - Essential for setting financial strategies and negotiation standards that align with organizational goals.
- Directs the activity required to coordinate all reimbursement recommendations submitted to committees and the Board of Directors - Crucial for ensuring cohesive policy direction and implementation across the organization.
- Directs the development of analytics capabilities to identify utilization patterns and billing practices - Key for leveraging data to inform strategic decisions and identify areas for improvement.
- Directs activities related to research and monitoring of ongoing reimbursement programs as well as development of new programs - Important for fostering innovation and staying ahead in the healthcare industry.
- Directs the methodology of alternative payment models to improve quality of care and control total cost - Critical for developing forward-thinking payment strategies that can lead to better health outcomes and cost savings.
- Collaborates with provider groups to develop and administer alternative payment agreements - Vital for building strategic partnerships that enhance value-based care models.
- Directs research of medical and administrative policies and procedures in response to new medical procedures, contract coverage, and content of service issues and/or product development - Essential for keeping the organization's practices up to date and compliant with industry standards and innovations.
- Develops policies, procedures, guidelines, instructions, forms for the administration, reporting, analysis, and all follow-ups of payment programs - Crucial for establishing clear and efficient operational processes and ensuring consistent follow-up and compliance.
- Assists staff in their efforts to improve the relationship, contractual and non-contractual, between BCBSKS and providers - While important, this is more of an operational task that could be managed by team members under the Director's guidance.
What you need
- Bachelor of Science degree with emphasis in Accounting-Business Administration, Healthcare Financing, Actuarial, Management, Economics, or similar.
- Minimum of seven years health care management experience with record of increasing responsibilities.
- Experience with provider billing and coding medical procedures is required.
- Experience with medical, pharmacy, and dental terminology, institutional and professional protocols, and business practices, procedures, and policies of professional and institutional providers is required.
- Health Economics Expertise: Requires a comprehensive understanding of health economics, healthcare fields, and an ability to create economic projections for medical service pricing based on trends.
- Provider Reimbursement Knowledge: Expertise in provider reimbursement methodologies and billing practices is essential.
- Complex Communication Capability: Ability to analyze and clearly communicate complex healthcare economic issues to senior leadership and providers.
- Effective Communication and Leadership: Must possess strong verbal and written communication skills and excel in applying human relations principles, with an ability to direct and manage personnel effectively.
Bonus if you have
- Experience working with statistical/actuarial theories based on trends combining cost and use is strongly preferred.
- Experience working with providers, the healthcare delivery model, key accounts, and provider licensing boards is preferred.
- Experience in management of health care delivery charge and reimbursement systems is preferred.
- Experience with provider policies and procedures, regulations, business procedures, professional procedure code and nomenclature is preferred.
Compensation
BCBSKS Grade: Exempt 21
Salary determined based on education, skills and experience
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