Manager of Provider Reimbursement

Job Summary

The Manager of Provider Reimbursement is responsible for leading a team and overseeing and developing provider reimbursement programs and strategies for new and existing provider types. This position directs payment activities to achieve the most cost-effective and accurate health care spending while improving overall health plan efficiency.

This opportunity is available for internal and external applicants. This position is located in our Fargo, ND office with some flexibility to work remotely 1-2 days a week, after training. We empower our employees to find a work style that is best for them. Click Life at Blue | BCBSND to learn more.

Pay level: 026

FLSA category: Exempt-Salaried

Essential Functions

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  Leads and guides employees in accomplishing work objectives within the unit(s). Coaches, motivates, rewards, and recognizes employees. Sets clear goals and objectives, sets performance expectations, and holds employees accountable for achieving results.
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  Leads the development of payment and reimbursement strategies that support strategic goals of the department with input and support from senior level management and divisional leaders.
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  Plans strategies, develops budgets and directs policies and activities related to reimbursement programs, managed care, and value-based payments.
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  Establishes effective partnerships and collaborates with internal teams and external stakeholders to ensure pertinent data is captured, analyzed, and interpreted to translate data-driven insights into clear strategic priorities.
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  Continuously monitors and researches reimbursement standards and regulations and updates policies and procedures, as needed.
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  Oversees the multi-disciplinary reimbursement advisory group and is responsible for coordinating payment related activities.
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  Reviews department work to ensure appropriate guidelines are followed, training is provided, and monitors workload inventory to ensure timely completion.
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  Prepares operational reviews related to discount percentages, payment information and other relevant data for senior leadership and other divisional leaders.
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  Develops strategic, cost-effective programs, and makes system or network changes to enhance competitive position.
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  Communicates complicated matters in a simple, structured way to internal and external stakeholders.
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  Monitors trends in the reimbursement industry and provides timely information to assist the leadership team in the development of strategic corporate goals.

Knowledge, Skills and Abilities

Education Requirements

Experience Requirements

Certification, Licensures & Registration Requirements

Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

Physical Demands

Other Information

Job Posting Policy

Employees new to Blue Cross Blue Shield of North Dakota are eligible to apply for positions within their assigned department after successfully completing 90-days in their role. For positions outside of their department, new employees should attain a minimum of six months of service before applying for a new role. Exceptions to this are acceptable, provided there is good business justification for making the move.

Equal Opportunity Employment

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email [email protected]

This job posting will be closed 9/8/2022 at 8:00AM CST. No further applications will be considered.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)