**Please note: This position is with Nova, a division of Independent Health Corporation (a subsidiary of Independent Health).**
The Supervisor, Stop Loss and Cost Containment, will be responsible for oversight of the cost containment analyst and stop loss administrator(s). He/she will be responsible to coordinate efforts to control medical expense through negotiation with non-participating providers, facilitation of efforts with cost containment vendors, cross functional operational initiatives, pre-payment, concurrent and retrospective reviews of claims and medical records to assure payment is appropriate for services provided. Coordinate and oversee the re-pricing process with external Preferred Provider Organizations, and coordinate the administration of stop loss. Contribute to research and implementation of industry best practices in the area of cost containment and Stop loss administration. Oversight responsibility for executing all processes relating to stop loss marketing, proposals and placement.
Bachelor’s degree from an accredited institution. Experience in self-funded insurance operations preferred. Extensive supervisory experience in healthcare claims administration may be considered in lieu of degree.
A minimum of five (5) years experience in self-funded health care industry, with at least two (2) years of supervisory experience. Direct experience in cost containment and stop loss administration is preferred.
Working knowledge of medical and dental benefit designs and interpretations.
Excellent interpersonal skills with ability to establish effective communications with providers, physicians, brokers, carriers, senior leadership, and staff. This shall include oral and written communication skills.
Experience with insurance carrier negotiations, placement and contracting preferred.
Experience with negotiation strategies related to health care claims.
Financial analytical skills with exceptional proficiency in math required.
Effective management skills; autonomous, independent worker; project and process management skills and experience in utilizing data to drive outcomes and provide systemic, timely tracking and reporting.
Knowledge and experience with medical policy, coding, claims payment and auditing clinical records to establish appropriate operational procedures.
Demonstrated problem solving, decision making, organizational and time management skills.
Strong computer skills. Proficiency in Word, Excel and Power Point required. A working knowledge of core business systems preferred.
Must exhibit initiative, decisiveness, and creativity, along with self-motivation with the ability to assume responsibility and maintain strict confidentiality.
Understands the importance of maintaining the physical and technical security and privacy of protected health information (PHI).
Other duties as needed. Every associate is given a job description upon hire outlining the qualifications, duties, and pay grade of the position. Nova Healthcare reserves the right to change job descriptions as necessary. Associates will be given notification of such changes as they occur.
Independent Health is an equal opportunity employer.
Independent Health - 20 months ago