Director Reimbursement

Job DescriptionFortune 4 CVS Health has an exciting opportunity for a Director Reimbursement to join our dynamic team As the Director Reimbursement you will be responsible for providing strategic support to revenue cycle operations and challenge assumptions and standards of business in an effort to improve overall operational effectiveness and service to CVS Health customers. Leveraging your expertise in process improvement, change management and adherence to Corporate Integrity, you will be responsible for developing, staffing and managing a department that fosters collaboration across the operations, with a focus on continuous revenue cycle improvement and alignment with the long-term strategic goals of business.Responsibilities: 1. Develop and maintain a strong revenue cycle leadership team and staff through effective recruitment, talent management, creation of a collaborative results-oriented culture, and a focus on continual improvement and provide direct oversight to billing and collections operations ensuring departmental performance goals are met.a) Monitor and trend department performance metrics on a daily and monthly basis. Investigate variances and resolves any issuesb) Maintain primary responsibility for resolving all payer issues while leading discussions with Payers, Sales and Legalc) Assure compliance for all regulations associated with Government directed programs within the A/R area2. Drive process innovation activities and strategic solutions to improve our operational efficiency and effect change management within the business, to ensure the department is positioned for long-term success3. Elevate customer service levels4. Maintain accountability for providing leadership and financial reporting and support across the revenue cycle operations, including month-end close activities.5. Participate in revenue cycle strategy development as a thoughtful leader and content expert, sharing best practices, optimizing performance, and leading the transformation.6. Evaluate new vendor capabilities, participate in the contracting process and support subsequent onboarding and go-live activities7. Responsible for managing policy and procedure development and adherenceThe successful candidate will have knowledge of the following: Specialty pharmacy and/or post-acute operations Revenue cycle applications and healthcare finance and accounting principles Federal, state and commercial payer reimbursement rules and regulations Revenue consulting experience managing complex transformation engagementsRequired Qualifications Minimum 10 years of experience in healthcare industry, including health insurance, PBM or pharmacy services Minimum 5 years of experience in leadership roles Collections experience or other direct Customer facing experience Domestic Travel Required up to 20% of timeCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Experience in healthcare industry, including health insurance, PBM or pharmacy services Experience in highly regulated industry and compliance environment Experience with Vendor Relationships Exceptional verbal, interpersonal, and written communication skills Excellent organizational skills and attention to detail Ability to lead complex projects and work within timeline and resource constraints Strong leadership skills and commitment to a team approach; both direct and indirect reports Ability to influence key stakeholders at various organizational levels Experience with compliance and/or quality improvement programs Ability to multi-task and manage multiple projects or trainings at one time Strong working knowledge of Windows-based software applications (e.g., Word, PowerPoint, Excel, Visio) Masters Degree PreferredEducationBachelor Degree or equivalent experienceBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2024-10-19