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Director, Provider Reimbursement
at Beacon Health Options
Cypress, CA

Director, Provider Reimbursement
at Beacon Health Options
Cypress, CA

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Description

Beacon Health Options

Job Category: Provider & Network - General
Req #: DIREC01901
Schedule: Full Time
Location: CA - Cypress


We Help People Live their Lives to the Fullest Potential!

For more than 30 years, Beacon has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 40 million people across all 50 states. At Beacon, we are committed to delivering a 'world-class' candidate experience from the moment you click 'Apply'! Our goal is to help you reach your fullest potential, while utilizing your talents and expertise to help us deliver on our promise.

Do you have a passion for helping others? If so, we are looking for you!

Beacon is currently seeking a Director, Provider Reimbursement a highly organized and compassionate professional to join our team. The Director of Provider Reimbursement is a highly visible team lead among internal and external stakeholders. The Director of Provider Reimbursement leads a team of analysts that identify, define and update provider facility and professional fee schedules. This role also supports Beacon's provider reimbursement strategies as set forth by Market and Regional leadership, leveraging the organization's matrix structure to engage and coordinate support cross-functionally among key stakeholders.

The Director of Provider Reimbursement is develops and maintains the behavioral health reimbursement methodologies for existing, as well as new markets for facilities and professionals.

What does a typical day look like?
  • Lead the development/updating and facilitation of the annual loading of benchmark facility and professional fee schedules (Medicare, Medicaid, and Beacon Proprietary) in conjunction with each Region's provider strategy.
  • Serve as the Enterprise subject matter expert regarding reimbursement, fee schedules and rates for new client implementations and upsells for existing clients. Drive implementation activities related to reimbursement.
  • Train and mentor team resources to build core reimbursement knowledge and promote analytical standards and best practices.
  • Lead the implementation of cycle as well as off cycle code additions/deletions to benchmark fee schedule and update existing Beacon fee schedules for cross-walked codes.
  • Facilitate/direct analytical resources to determine the financial impact of updated professional fee schedules for both risk and ASO business.
  • Secure the appropriate grouping/pricing software necessary to support facility contracting for all lines of business in all Divisions/Regions.
  • Lead the development and maintenance of desktop modeling tools for professional rate increases.
  • Develop/utilize reporting tools to index facility rates by level of care and place of service as a percent of benchmark reimbursement levels.
  • Support and participate in the Network Strategy department's process improvement and transformational initiatives to drive completion and successful outcomes.
  • Develop strong provider and Regional relationships built on trust and collaboration. Manage and balance Beacon and provider expectations.
  • Act as liaison and maintain productive working relationships with all Beacon departments.
  • Other duties as assigned.

  • What you Contribute?

    Education: Bachelor's Degree required.

    Licensure: N/A

    Knowledge, Skills & Abilities:
    • Five - Seven (5-7) years of progressively responsible professional experience, with at least three (3) of those years with a provider-facing role
    • Three (3) years of provider relations and/or reimbursement experience
    • Three-five (3-5) years healthcare payor (including managed care) experience preferred
    • 2+ years of multi-state provider management experience preferred
    • Experience and comfort with financial model and detailed data analysis

    What Makes Us Different?
    • Here, it's not just a job - it's an opportunity to change lives.
    • Our employees are learners, innovators and original thinkers.
    • Our mission and values guide the way we treat our members, providers and each other.

    What We Have to Offer:
    • Healthcare benefits available starting day 1!
    • Health & wellbeing incentives, such as gym membership reimbursement
    • 401K with company match to help reach your future financial goals
    • Generous PTO, because we know life happens outside of work
    • Tuition reimbursement so you can keep reaching your fullest potential

    If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started!

    Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

    At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.

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    PM16

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