Manager Provider Pricing
Oversees the daily operations of provider pricing configuration for one or more THP product lines and programs, including Commerical HMO, Commercial PPO, Medicare Advantage HMO, Medicare Advantage PPO, Medicaid and/or Public Employees Insurance Agency (PEIA).
- Five (5) years experience in managed care setting in provider pricing / provider configuration, provider contracting or claims;
- Mastery of of standard health care industry coding (CPT, HCPCS, ICD-10);
- Superior knowledge of State (West Virginia and Ohio) and Federal regulations regarding fee schedules, payment policies, including Correct Coding Initiatives, and payment programs, such as MACRA and MIPS;
- Comprehensavie experience implementing standard government programs fee schedules and alternative payment methodologies, including bundled payments, episodes of care, and pay-for-performance incentives;
- Strong customer service orientation;
- Advanced critical thinking and problem solving skills;
- Superior verbal and written communication skills;
- Mastery of Microsoft Word, Excel, Power Point and Outlook.
- At least two years experience in a management capacity;
- Medicaid and Medicare Advantage provider pricing / configuration experience.