Summary

Provides overall executive leadership and responsibility for the effective and efficient control of all functional operations of the Medicare Provider Reimbursement area, which includes the Institutional and Professional Reimbursement areas. Formulates strategy for the reimbursement area to meet operational metrics and customer requirements.

Description

60% Ensures effective and efficient contract performance, to include reimbursement performance standards, budget goals, process improvements and innovation/automation opportunities. Ensures that all contractual and/or corporate standards and requirements are met and all applicable guidelines are followed. Responsible for financial planning and budget control. Works with CMS, various Medicare contractors and internal/external partners to help them understand Medicare FFS reimbursement methodologies.

20% Directs hiring, training, and development of skilled staff (including corrective action and performance reviews) and selects company subcontractors. Provides objectives, workload requirements, and performance plans for all resources. Develops and manages the budget from preparation and submission to adherence to government funding requirements.

20% Establishes and maintains effective working relationships with all internal and external customers.

Required Education:

• Bachelor’s degree – Accounting

Required Specialized Training:

• Proficient knowledge and functional experience in Medicare Financial Management and/or Provider Audit and Reimbursement.

Required Work Experience:

• Ten years-Medicare reimbursement experience.
• Five years-management experience OR equivalent military experience in grade E4 or above (may be concurrent if in Medicare reimbursement).

Required Skills and Abilities:

• Must have strong management, communication, decision-making, and analytical skills.
• Must have a working knowledge of the various current forms of health care delivery systems utilized.
• Must understand Information Systems processes to solve operations and strategic problems.
• Demonstrated proficiency in mathematical calculations and general principals of managing standards of performance.
• Must have thorough understanding of business statistics to be able to make decisions on staffing, budget, etc., based on the analysis of data.
• Must be able to understand the claims processing system and support systems.
• Must possess understanding and experience in responding to Requests For Proposal (RFP) to support current business and/or the development of new business.
• Presentation skills are required.
• Must have experience in budget planning, preparation and monitoring.
• Must have strong, decision making skills to promote a culture that ensures employees conduct business in compliance with laws, regulations, policies, and procedures in accordance with our Corporate Values.

Required Software and Other Tools:

• Microsoft Office.

Preferred Education:

• Master’s degree – Business Administration or Account

Preferred Work Experience:

• Thre e years of functional/operational experience in Medicare Financial Management and/or Provider Audit and Reimbursement.

Preferred Licenses and Certificates:

• Certified Public Accountant (CPA)

Work Environment:

• Typical office environment. Some travel between office buildings required.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.