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Posted: Monday, February 5, 2018 1:53 PM

Director of Reimbursement Services
Requisition ID: 135993
Department: 500620 Reimbursements Services
Facility: Hometown Health
Schedule: Full Time Eligible for Benefits
Shift: Day
Hours: 8-5pm
Category: Management
Location: Reno, NV
Position Purpose: This position acts as the primary resource for the health plan in all aspects of reimbursement and self funded operations. The position is responsible to ensure claims and all self funded claims are processed in an accurate and timely manner according to Health Plan procedures, Department procedures, State and Federal Regulations and Laws, member benefits and provider contractual agreements. Also, to contribute to the development and implementation of a provider contracting strategic plan, as well as participating in negotiating contracts with optimal rates. Once contracts are negotiated, this position has the responsibility to ensure the contracts are loaded into the claims processing system timely and accurately. To further ensure accuracy of contract loads, this position will be responsible for all claim audits and resolve any payment discrepancies. Also, position is expected to develop and implement a business growth strategy in conjunction with Sales and Service, development of a basic reporting package and ad-hoc report capabilities, tracking and managing reinsurance programs for all self funded clients. Once a client contracts for self funded services, this position has the responsibility to ensure the set up, transition and implementation occurs timely and accurately. This position is responsible for the fiscal performance of the Department and its relationship to the Health Plan and Organization. This position serves to support the COO in the successful achievement of the objectives of the organization.
Nature and Scope: This position is responsible to ensure the accurate and timely payment of claims for the health plan and self funded clients. The position is also responsible to ensure Hometown Health s contracts negotiated with providers are at optimal rates and administrable. Each contract should be able to be viewed electronically by members of other departments to provide clarifications that may be necessary. In order to accomplish this task this position shall determine and manage the Department to the approved fiscal budget. This Department shall ensure appropriate staffing and staffing responsibilities are maintained in order to meet the Department and health plan objectives. This position shall ensure an appropriate training program is in place for Department staff. This position shall coordinate and monitor changes pertinent to the on-line claims processing system, claims processing system, benefit setup, enrollment, reinsurance coordination, reporting and client management. This position shall be responsible for ensuring appropriate Departmental policies and procedures are developed and implemented. This position shall serve as the Departmental liaison between other health plan departments, Renown Health and other internal and external customers. This position shall ensure coordination of benefits and subrogation (third party liability) procedures are in place for the health plan. This position shall develop, implement, and participate in quality improvement and change management procedures and processes.
1. Excellent interpersonal and verbal/written communication skills required. Written and verbal skills shall include ability to make presentations to Executive/Senior Management of the Health Plan, Renown Health Senior Management, Providers, Employer Groups and other internal/external customers. 2. Ability to manage change and to obtain operational results with minimal disruptions through innovative and creative means. 3. Proven budget preparation skills and proficiency in the monitoring and adjustment of resources to ensure operational efficiency.
4. Leadership ability in the strategic planning process, including the ability to identify and work with individual strengths and weaknesses. 5. Ability to read, analyze and interpret general benefit, contract, systems, governmental regulations and develop claims and technical procedure manuals. 6. Ability to calculate percentages/ratios to determine cycle time, accuracy/error rates of claims adjudication and other related functions and ability to compare these measurements to historical and industry benchmarks. 7. Excellent analytical and problem-solving skills to identify problems, issues, errors and determine whether causes are of system, procedural and/or clerical in nature; ability to make recommendations for quality improvement and/or change management.
This position does not provide direct patient care. The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job. Minimum Qualifications: Requirements Required and/or Preferred Education: Must have working-level knowledge of the English language, including reading, writing and speaking English. Bachelors Degree in business or related field required, experience can be substituted on a year for year basis; Masters Degree preferred. Experience: Five years of healthcare experience in a managed care environment. Three years of management experience. Prior experience must include Claims, Contract Negotiation, Provider Relations, Customer Service, Quality Assurance, Project Management, Coordination of Benefits and Subrogation. Thorough knowledge and application of CPT, ICD9/ICD10, HCPCS, ASA, ADA and DRG coding. Knowledge of State and Federal rules and regulations. Six Sigma or comparable preferred. License(s): None Certification(s): None Computer / Typing: Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. EEO/M/F/Vet/Disabled
Renown s Values
As the area s only not-for-profit and locally-governed healthcare network, we pride ourselves on quality care for the community.
In order to do that, we provide employees with an environment and culture that supports growth and empowers you to do their best every day.
Our employees share our commitment through our mission, vision and values.
Our Mission: To make a genuine difference in the health and well-being of the people and the communities we serve.
Our Vision: With our partners, we will inspire better health in our communities.
Our Values: We are caring and compassionate. We demonstrate respect and integrity. We collaborate with our patients, families, physicians and communities. We strive for excellence in all we do.
Quality care for our patients requires the contributions of every person on the team. We can t do it alone. We re looking for employees with a winning spirit whose values are aligned with Renown Health.
Associated topics: administrative assistant, administrative staff, asso, document, facilities, front desk, front office, food, operational assistant, operations director


• Location: Reno

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