Claims & Reimbursement Analytics Manager

Medica; Omaha (NE); On-site; USD 79,000 - 135,000; Full time

Job summary

Medica is seeking a Manager, Coding to lead Payment Analytics and Reimbursement Policy. You will oversee audits, reporting, and vendor management, driving improvements in claim payment accuracy and recovery of overpayments.

The role requires 7+ years in claims and coding, 5+ years of people leadership in healthcare, and a Bachelor's degree or equivalent. You will interact with senior leadership and coordinate with cross-functional teams in a multimarket environment.

Qualifications

• 7+ years of work experience in claims and coding beyond degree.
• 5+ year of people leadership in healthcare operations.

Responsibilities

• Develop executive reporting package
• Comprehend Medica’s contracting strategy and how it relates to our provider reimbursement and system capabilities
• Report overpayments or suspected fraudulent behavior to our Special Investigations Unit (SIU)
• Monitor, manage and report financial impact to management
• Maintain reporting structure by ensuring consistency to both internal and external customers
• Improve processes through automation and/or efficiencies in process
• Review and analyze team findings on a monthly, quarterly and annual basis to identify trends, areas for focus and improvement
• Assure processes are auditable (able to be reperformed with a paper/electronic trail)

Skills

Leadership

Analytical skills

Strategic thinking

Education

Bachelor's degree or equivalent experience in related field

Job description

Medica is seeking a Manager, Coding to lead Payment Analytics and Reimbursement Policy. You will oversee audits, reporting, and vendor management, driving improvements in claim payment accuracy and recovery of overpayments.

The role requires 7+ years in claims and coding, 5+ years of people leadership in healthcare, and a Bachelor's degree or equivalent. You will interact with senior leadership and coordinate with cross-functional teams in a multimarket environment.