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Senior Director, Payment Integrity and Reimbursement
Banner Health
| Primary City/State: Phoenix, ArizonaDepartment Name: Fiscal ServicesWork Shift: DayJob Category: General OperationsBanner Health believes leadership matters. We look for people who share our vision making health care easier, so life can be better. Our leaders are at the front of the health care transformation, planning the future of Banner Health. As the Banner Health Network continues to grow, the role of Senior Director of Payment Integrity and Reimbursement will lead efforts in risk adjustment , e ncounters and claims recovery . In this highly visible role you will lead and execute strategic initiatives in alignment with organizational goals while ensuring compliance with state and federal regulatory requirements. You will have solid knowledge and experience in the insurance division with a specific focus in a Medicare plan. As a subject matter expert, you will review, prepare, analyze and present recommendations to the Banner Health Network executive leadership team to aid in decision-making. You will be an experienced leader with a proven track record in execution and influence at the highest level, as we are transforming as an organization in innovation. Your pay and benefits are important components of your journey at Banner Health. This opportunity is also eligible for our Management Incentive Program, as part of your Total Rewards package. Banner Health offers a variety of benefits to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life. Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.POSITION SUMMARY This position is responsible for leading the execution of payment integrity, strategy, risk adjustment and encounter submissions to CMS and the State for all of the Insurance Division. This role will be responsible for the execution of strategic initiatives, plans, and goals in alignment with organizational vision and goals. The candidate will engage in primary duties including operational planning and oversight, as well as resource, relationship, and people management. There will be direct operational payment integrity activities across the organization in support of all lines of business. Ensures payment integrity processes are in compliance with Federal and state regulatory and contractual requirements. This position will effectively use business intelligence and data analytics to monitor operations and identify cross functional process improvement opportunities. CORE FUNCTIONS 1. Directs, supervises, and evaluates the work of direct staff and matrixed employees. 2. Participates into the development of the department budget to meet corporate goals and objectives. Meets annual budgetary goals. Translates organizational plans, goals, and initiatives into assumptions for annual operating and/or capital budgets. Negotiates contracts with external vendors for products and/or services and monitors/evaluates quality and/or performance. 3. Directs and participates in the development, implementation, and consistent application of effective organizational policies, procedures, and practices. Develops and supports internal controls to ensure that assets are safeguarded, policies and operating procedures are followed, necessary controls are effective and efficient, and compliance with current laws and regulations is achieved. 4. Reviews, prepares, analyzes, and presents reports and recommendations to senior leadership regarding operations, programs, services, and/or other applicable areas of interest in order to provide concise and accurate information that aids in decision-making. MINIMUM QUALIFICATIONS Bachelor's Degree in applicable field of Finance, Economics, Statistics, Mathematics, or Healthcare Administration. Depending upon assigned area of responsibility, position may require applicable certifications and/or licensures, including but not limited to: RN; MD or DO; Driver's License; Certified Healthcare Protection Administrator (CHPA); Certified Protection Professional (CPP); Chartered Property Casualty Underwriter (CPCU); Associate in Risk Management (ARM); CPA; SPHR; Registered Health Information Administrator (RHIA); Registered Health Information Technologist (RHIT); Certified Healthcare Facility Manager (CHFM); Certified Facility Manager (CFM); Certified Coding Specialist (CCS); Certified Professional Coder (CPC); JD from an American Bar Association accredited school; admission to a State Bar Association. Significant technical and managerial, typically gained through seven plus years relevant experience. Ability to produce superior results in a financial performance-oriented environment. In depth understanding of claims processing, within a managed health care or health insurance business model. PREFERRED QUALIFICATIONS Health Operations Experience. Payment Integrity, such as Claims Editing, Enrollment, Coordination of Benefits, Overpayment Identification, Claims Auditing, FWA, Risk Adjustment, Encounters. Additional related education and/or experience preferred.
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