Director, Medical Payment Operations

Provide leadership and direction to Medical Payments and Bill Review Team. Act as a primary, independent, visionary, and proactive authority; providing in-depth analysis of medical payments areas. Collaborate with Brand Leadership, Corporate Claims, and OGC/Compliance to ensure timely and accurate medical payments in compliance with statutory and regulatory requirements.

Requirements

• Plan, direct, manage and evaluate the day-to-day operations and workflow of production, claims management and customer teams.
• Consult with Claims, Corporate Claims, Government Affairs and OGC leadership across the organization to provide necessary support and feedback.
• Serve as lead contact and oversees the management of the Medical Bill Review software partner and any outside review vendors.
• Attend industry functions with regulators, vendors and peer groups, to represent AF Group to ensure best in class medical bill review program.
• Responsible for the development, implementation and maintenance of the Medical Bill Review Quality Assurance Program.
• Responsible for staying current on changes in workers’ compensation statutes and cases; medical fee schedules and reimbursement methodologies as well as subrogation and recovery laws and procedures.
• Conduct and/or direct advanced statistical analysis and research related to medical reimbursements, claims and claims operations.
• Oversee and manage strong, professional working relationships with state regulatory agencies, as well as vendors, by serving as a key contact.
• Collaborate with appropriate parties in root cause analysis and minimization of delays, surcharges, fines, and penalties.
• Participate in development of annual departmental budget.
• Establishes and monitors KPIs and SLAs for departmental success and compliance.

Benefits

• Generous Paid Time Off
• 401k Matching
• Retirement Plan