Required:
Strong understanding of managed care contracts, benefit structures, payment methodologies, and authorization requirements.
Strong interpersonal leadership skills and an ability to motivate and develop talent while driving accountability.
Extensive understanding of the application of the Division of Financial Responsibility (DoFR) to claims processing.
Extensive knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases (ICD)-10, DRG/ Ambulatory Payment Classification (APC), and pricing methodologies.
Deep study and understanding of managed care contracts and payment methodologies and provide contract interpretation.
Strong project leadership and management skills required; ability to manage multiple priorities, complex workflows, and high-volume environments.
Proficiency with Microsoft Office and data/reporting tools.
Exceptional presentation skills, written and verbal communication skills, including executive communication skills with the ability to produce audit-ready documentation.
Must be highly collaborative and maintain a consultative style with ability to establish credibility quickly with all levels of management across multiple functional areas.
Must be able to present findings to various levels of management, across all organizations.
Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization.
Demonstrated ability to make sound and timely decisions.
Demonstrated ability to adapt to changing situations and adjust strategies accordingly.
Demonstrated ability to adapt to a fast-paced and evolving environment and to lead others through change.
Excellent interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment.
Excellent ability and knowledge in analyzing data, identifying problems, and making informed decisions, often in complex or ambiguous situations.
