Manager for Sexual and Reproductive Health and Rights at CIFF focusing on Health Systems Access programs. Leading initiatives to improve equitable access to health services for vulnerable populations in the Sahel region.
About the role
- Payor Relations & Clinical Criteria Manager overseeing healthcare coverage criteria and leading a team. Focusing on Medicare, Medicaid, and Commercial payors' billing rules and operational accuracy.
Responsibilities
- Leading, developing, and mentoring a team responsible for monitoring, analyzing, and interpreting healthcare coverage criteria changes across Medicare, Medicaid, and Commercial payors.
- Defining and governing payor criteria and billing rules aligned to payor manuals, contracts, and payor behavior to support operational accuracy and future-state decision support capabilities.
- Developing and maintaining master data structures for payor billing rules, clinical coverage criteria, and medical necessity requirements to support consistent execution across the revenue cycle.
- Communicating and educating Homecare Operations and Billing & Collections teams on evolving coverage requirements, documentation expectations, and payor-specific billing rules.
- Driving revenue cycle performance by strengthening payor-related processes, resolving AR issues tied to payor system/process defects, and partnering cross-functionally with Managed Care Contracts, MCO Sales, Contracting, Operations, and Billing teams.
Requirements
- Bachelor’s degree or higher from an accredited institution and seven (7) years of experience in healthcare revenue cycle, payor policy, managed care, and/or billing criteria OR High School Diploma/GED from an accredited institution and eleven (11) years of experience in healthcare revenue cycle, payor policy, managed care, and/or billing criteria
- Five (5) years of people leadership experience in revenue cycle, clinical documentation, and/or payor relations
- Strong working knowledge of Medicare, Medicaid, and Commercial coverage criteria
- Strong contract analysis and interpretation skills
- Proven ability to analyze complex regulatory and coverage policy changes and translate them into operational guidance
- Excellent communication skills with demonstrated ability to educate clinical, billing, and operational partners effectively.
Benefits
- Medical
- Dental & Vision
- Health Savings Accounts
- Health Care & Dependent Care Flexible Spending Accounts
- Disability Benefits
- Life Insurance
- Voluntary Benefits
- Paid Absences
- Retirement Benefits
Job title
Job type
Experience level
Salary
Degree requirement
Location requirements
Site Manager overseeing daily operations at customer facilities for Ecolab's Global High - Tech group. Ensuring compliance and managing a service team's execution across facilities in North Dakota and Minnesota.
Lifecycle and Automation Manager enabling smarter use of energy at scale with Tibber. Join us to contribute in making energy transition happen with innovative marketing strategies.
EHS Manager providing onsite health and safety support at client facilities focusing on compliance and risk management. Ensures effective strategies for safety issues across industries.
Manager for Media Strategy & Planning at GEICO driving strategy and media execution. Leading advertising across television, radio, digital, and social channels.
Evidence Generation Manager for Sanofi conducting and overseeing real - world evidence studies. Strategic leadership and collaboration with global experts to support pharmaceutical product lifecycle.
Manager audit responsible for leading audit missions and developing client relationships within a dynamic team. Involved in strategic audit planning and resource allocation while ensuring compliance with standards.
Manager overseeing technical support for Stryker customers by field engineers and specialists. Requires 8+ years of experience and a Bachelor's degree.
ES&H Manager supporting operations at DOE National Energy Technology Laboratory. Managing and implementing ES&H programs while mentoring specialists and ensuring compliance with health and safety regulations.
Manager overseeing verification and validation strategies for autonomous driving systems at Zoox. Leading a team to ensure safety and reliability before public deployment.