Job Summary

Supervises the provider contract reimbursement set up and monitors the billing activities of providers to ensure correct payment is in accordance with contract terms, policies, and procedures. Manages department objectives by creating, maintaining, and monitoring policies, procedures, metrics, and guidelines. Manages internal interactions with hospital and provider billing department to ensure high levels of quality and efficient work is in place.

Essential Functions

• Accountable for resolution of implementation and support issues, leader of collaboration with support teams to troubleshoot and resolve escalated incidents and problems, using established procedures for problem and situation management.
• Serves as a resource to all team members. Mentors new staff, and less experienced team members, and serves as a role model for customer service excellence.
• Acts as project leader on the most complex special projects utilizing project management and technical computer skills to ensure all project activities are completed in an accurate timely manner.
• Monitors federal regulatory changes and other appropriate sources for rule revisions associated with payment policies.
• Lead small scale project and process implementation by identifying tasks, dependencies, responsibilities, quality checks and milestones. Identify issues and drive resolutions.
• Participates in core work groups to recommend and direct process development. Identifies needs, develops, and conducts education, orientation, and training, establishes evaluation and effectiveness measurement.
• Works closely with Provider Reimbursement Manager to ensure all established procedures and workflow are followed within the department.
• Participates in committees related to the team to provide feedback and ensure that the department is represented in corporate-wide activities and functions.
• Lead teams in obtaining and analyzing functional and system requirements for complex corporate initiatives and provide expert system consultation, analysis, and recommendations to ensure that the development solutions support the business needs. 
• Extensive and comprehensive knowledge of business processes, including but not limited to provider reimbursement methodologies, provider data, provider networks, and claims processing.
• Strong analytical and systems/relational analysis skills.
• Exceptional written and verbal communication skills.
• Proven team leadership skills to influence and guide team members toward department goals.
• Proven competency in analyzing business needs and working across both technical and nontechnical teams.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance
• Traditional and Roth retirement options with service contribution and match savings

Qualifications

Required

• Bachelor's Degree or equivalent
• 3 years of relevant experience working with UB92 or 1500 billing (preferable hospital billing)
• 3 years of relevant experience working with provider reimbursement methods in Medicare/Medicaid/Commercial spaces
• 7 years of relevant experience using Microsoft applications including Word, PowerPoint, Excel and Business Objects

Preferred

• Supervisor and/or leadership experience
• In-depth knowledge of Facets data structures, systems flows and process flows, including knowledge of third party integrated and target systems.

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

Primary Location

SITE - Priority Health - 1241 E Beltline - Grand Rapids

Department Name

PH - Provider Reimbursement

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8:00 a.m. to 5:00 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.