AVP Payment Configuration
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At a glance
Job overview
Healthfirst is hiring an AVP Payment Configuration. The AVP Payment Configuration implements and maintains reimbursement rates and pricing methodologies for provider contracts, ensuring accurate claim pricing. This role involves configuring benefits to meet various requirements, ensuring configuration quality, and managing provider contract requests and database setup. The AVP also oversees credentialing, evaluates strategic plans for provider payment, and develops an effective team.
Key focus areas include Implement and maintain configuration of reimbursement rates and pricing methodologies, Ensure configurations accurately match fee schedules and negotiated rates to contracts, and Implement configuration of benefits to meet Product, Clinical, Medical Cost Management, and Regulatory requirements.
Successful candidates bring Bachelor's Degree Or Equivalent, High School Diploma Or GED, and Managing Others Experience. Important skills include Medicare, Medicaid, Commercial Healthcare, Strategic Thinking, Problem Solving, and Communication To Cross-Functional Groups. Preferred (not required): Claims Configuration, Onboarding, Credentialing, and Excellent Communication Skills.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
This position requires three days per week in office (Tues/Wed/Thurs) at 100 Church Street, NYC
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Implement and maintain the configuration of reimbursement rates and pricing methodologies needed to support contract terms with providers including contracted and out of network providers
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Ensure configurations accurately match fee schedules and negotiated rates match contracts so that claims are priced accurately
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Implement configuration of benefits to meet the needs of Product, Clinical, Medical Cost Management, and Regulatory requirements
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Ensure the quality of the configuration to meet outcomes aligned with the stakeholder requirements
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Ensure intake of provider contract related requests including gathering of all contract terms, contract creation, provider demographics & documentation required to validate a provider's eligibility and credentials for the purpose of providing care to our members
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Ensure proper set-up and maintenance of our Provider Database across Healthfirst systems including but not limited to new provider loading as well as changes and/or terminations of existing provider records thereafter
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Ensure appropriate systems testing, procedure/control development, and ongoing improvement
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Ensure all NY state and federal compliance, audit and regulatory requirements are met
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Oversee credentialing workflow and policies to ensure they are compliant and support timely loading of provider records
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Evaluate, develop, and recommend strategic plans to ensure modern and efficient Provider Payment experience
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Build, manage, develop, and continuously improve the Provider Payment experience to meet the diverse and dynamic needs of a growing, evolving organization
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Develop an effective team through hiring, training, coaching, and providing ongoing and constructive feedback
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Additional duties as assigned
Minimum Qualifications:
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Bachelors Degree from an accredited institution or equivalent work experience
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HS Diploma or GED from accredited institution
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Experience managing others in positions of increasing responsibility environment
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Prior experience within Health Insurance Operations
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Experience setting departmental strategy, communicating, and influencing impact and progress to senior leadership
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Experience with Medicare/Medicaid and Commercial Healthcare
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Experience thinking strategically and critically in developing solutions to complex problems
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Experience communicating to cross-functional groups within an organization
Preferred Qualifications:
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Experience in the operations and management of large-scale operational team(s)
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Prior experience within technical knowledge in one or more of the Provider operational areas: Claims Configuration, Onboarding and Credentialing
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Excellent communication skills (verbal/written)
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Change leadership skills coupled with exceptional relationship building and influencing ability
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Ability to problem solve and approach issues strategically
Compliance & Regulatory Responsibilities: Noted above
License/Certification: N/A
Hiring Range*:
Greater New York City Area (NY, NJ, CT residents): $168,900 - $258,400
All Other Locations (within approved locations): $168,900 - $258,400
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
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