Manager, Reimbursement Strategy

Newton-Wellesley Hospital(NWH); Brasil; Teletrabalho; BRL 521.000 - 759.000; Tempo integral

Resumo da oferta

A healthcare organization in Brazil is seeking a Manager for Reimbursement Strategy. The ideal candidate will manage strategies to optimize reimbursement and lead a team to ensure compliance with financial objectives. Required qualifications include a Bachelor's degree in Finance or Business Administration and 5-7 years of experience in reimbursement strategy. This is a remote position with a competitive salary range of $97,510.40 – $141,804.00 annually.

Serviços

Onsite meetings quarterly highly preferred

Remote work flexibility

Qualificações

• 5-7 years of experience in reimbursement strategy or payer relations.
• 3-5 years of supervisory or leadership experience.
• Certified Professional Coder (CPC) preferred.

Responsabilidades

• Lead the implementation and management of provider reimbursement methodologies.
• Manage a team responsible for fee schedule development and maintenance.
• Analyze reimbursement trends to identify opportunities for improvement.

Conhecimentos

Reimbursement strategy

Healthcare finance

SQL knowledge

Leadership experience

Formação académica

Bachelor’s Degree in Finance or Business Administration

Descrição da oferta de emprego

Job Summary

Manager, Reimbursement Strategy is within the Mass General Brigham Health Plan Holding Company, Inc. Network Strategy department. The role develops, implements, and manages strategies to optimize reimbursement from government programs, commercial insurers, and managed care organizations, ensuring processes are efficient, compliant, and aligned with the organization’s financial objectives.

Responsibilities

• Lead the implementation and management of all provider reimbursement methodologies (inpatient, outpatient, professional, ancillary) and develop new payment guidelines while annually reviewing existing ones.
• Act as the gatekeeper of all regulatory requirements related to provider reimbursement decisions.
• Manage a team of analysts and project managers responsible for fee schedule development and maintenance, coding and pricing, policy and procedure documentation, and claim editing.
• Provide subject‑matter expertise to Contracting and Provider Relations on reimbursement methodologies and leverage reimbursement standards in contract negotiations.
• Oversee the PPG implementation process for new or revised payment policies, assigning action items to staff and committee members.
• Coordinate with Medical Economics to perform impact analyses related to fee schedules or policy changes, defining methodologies, reviewing results, and producing executive summaries.
• Analyze reimbursement trends, policies, and payment methodologies to identify opportunities for improvement and maximize revenue.
• Collaborate with clinical, financial, and operational teams to align reimbursement strategies with the organization’s goals and objectives.
• Work with leadership to identify savings opportunities based on industry trends, regulatory changes, competitor analysis, and methodology changes.
• Monitor and assess payer performance—including reimbursement rates, denial trends, and payment timelines—to identify improvement opportunities.
• Oversee denial management processes, conduct root‑cause analyses, implement corrective actions, and develop effective appeals strategies to overturn denials.

Qualifications

• Bachelor’s Degree in Finance or Business Administration (preferred). Equivalent experience may be considered.
• 5‑7 years of experience in reimbursement strategy, healthcare finance, revenue cycle management, or payer relations.
• 3‑5 years of supervisory or leadership experience.
• Certified Professional Coder (CPC) preferred.
• SQL knowledge preferred to query data and build efficiencies.
• Experience leading direct reports.

Additional Job Details

• Monday–Friday Eastern Business Hours required.
• Onsite meetings quarterly highly preferred, not required.
• Remote employee must work from a quiet environment with Teams video required for both interview and work.
• Remote type: Remote.
• Work location: 399 Revolution Drive.
• Scheduled weekly hours: 40.
• Employee type: Regular.
• Work shift: Day (United States of America).
• Pay range: $97,510.40 – $141,804.00 annually.
• Grade: 8.

EEO Statement

Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. Reasonable accommodations will be provided for qualified individuals with disabilities.

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