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Job Title:
Director of Payor Strategy and ReimbursementAgency:
Department of Public Health
Job Requisition ID:
JR0000005040Shift:
Day (United States of America)Compensation Details:
$85,508.41 - $113,824.07Job Description:
Who We Are. We protect lives. The Georgia Department of Public Health (DPH) is the lead agency entrusted by the people of Georgia to protect lives and promote healthy lifestyles in communities throughout the state. We are committed to preventing disease, injury, and disability; promoting health and well-being; and preparing for and responding to disasters.
What We Offer. As a member of the DPH team, you will join a group of passionate individuals dedicated to serving Georgians. Regardless of your role, you will contribute to protecting lives while enjoying a wide range of benefits.
Make a Professional Impact – Build your career where it matters and protect lives in the community where you live, work, and play.
Enjoy Workplace Flexibility – Experience flexibility in how you work so you can be your best self for you and the people of Georgia.
Work with a Dynamic and Diverse Team – Collaborate with employees who share ideas and leverage collective strengths.
Achieve Career Longevity – Take advantage of opportunities for learning and development that support a long-term career.
Take Part in a Hands-on Working Culture – Work in a unique culture of active engagement and problem-solving, no matter your role.
Feel Pride in Where you Work – Be part of making an impact in public health alongside dedicated people just like yourself.
Job Summary:
The Director of Payor Strategy and Reimbursement leads the Georgia Department of Public Health’s efforts to strengthen reimbursement for public health services from Medicaid, PeachCare for Kids, Medicare, commercial insurance carriers, and other third-party payors.
The Director works with DPH program offices, Georgia’s 18 public health districts, the Georgia Department of Community Health, and other payor and government partners to identify reimbursable services, develop and recommend reimbursement methodologies, and address barriers to payment. This position evaluates program services, coding requirements, payor contracts, and operational workflows to help ensure DPH and public health districts receive appropriate reimbursement for covered services.
The Director also leads the development of processes and procedures for identifying patients within DPH programs who may qualify for Medicaid or other coverage and connecting those individuals with appropriate enrollment resources. The position monitors changes to Medicaid and other payor programs and works with DPH programs and public health districts to update operational procedures accordingly.
The Director serves as DPH’s principal strategic advisor on payor policies and provides leadership to guide programmatic and policy decisions.
Primary Duties & Responsibilities:
• Serves as DPH’s liaison with the Georgia Department of Community Health and develops effective working relationships with Medicaid managed care organizations, Medicare, commercial insurance carriers, and other third-party payors.
• Advises DPH leadership and public health districts on payor policies, reimbursement opportunities, coverage requirements, and changes affecting public health services.
• Identifies barriers that prevent or limit reimbursement and develops recommended solutions.
Reimbursement Strategy and Methodology Development:
• Leads assessments of DPH and public health programs to identify services that may be reimbursable by third-party payors.
• Develops and recommends reimbursement methodologies for DPH programs to maximize appropriate revenue.
• Develops standardized billing procedures, tools, resources, and best practices that can be implemented across DPH programs and public health districts.
Patient Coverage and Enrollment Processes:
• Leads the development of standardized processes for DPH programs to identify patients who may qualify for Medicaid, PeachCare for Kids, or other health coverage and directing them to appropriate enrollment resources.
• Works with public health districts to incorporate coverage screening and enrollment referrals into patient registration and service-delivery workflows.
Payor Policy Monitoring and Operational Implementation:
• Monitors policy changes that affect coverage or reimbursement and evaluate the operational and financial impact on DPH programs and public health districts.
• Develops recommendations for affected programs, including revisions to policies, procedures, billing rules, forms, training materials, contracts, and information systems.
Minimum Qualifications:
Bachelor's degree in health care services or related field from an accredited college or university and six (6) years of professional managerial or supervisory experience in health care services; or two (2) years of experience at the lower-level Sr Mgr., Health Care (HCM013) or position equivalent. Note: Some positions may require certification and/or licensure.
Preferred Qualifications:
• Strong understanding of Medicaid and other healthcare reimbursement systems, both public and private payor systems.
• Knowledge of revenue cycle, reimbursement methodologies and medical billing, including applicable billing and diagnosis codes.
• Familiarity with eligibility verification, coordination of benefits, claims submissions, appeals, and payment reconciliation.
• Strong project-management skills and demonstrated ability to coordinate initiatives involving several programs. Project Management Professional (PMP) or a comparable project-management credential is preferred. Demonstrated experience successfully leading complex healthcare reimbursement initiatives may substitute for certification.
• Strong written and verbal communication skills, including the ability to provide clear recommendations to executive leadership.
• Knowledge of DPH programs and the public health service-delivery system.
Additional Information:
The DPH Commissioner and agency leaders encourage all employees to engage in regular wellness activities and to make lifestyle choices that promote health and well-being.
The use of physical activity breaks during the workday is authorized to support this philosophy and help employees meet their wellness goals. A maximum of 30 minutes of physical activity may be allocated per workday, typically in the form of two 15-minute breaks or one 30-minute break.
Employment Information
State of Georgia employees are subject to the rules of the State Personnel Board regarding salary.
DPH accepts educational credentials recognized by the Council for Higher Education Accreditation (CHEA) and/or the US Department of Education (DOE) as valid. DPH will contact educational institutions to verify degrees, diplomas, licensures, and other relevant credentials.
The candidate selected for this position may be subject to pre-employment drug screening and a criminal background check.
Relocation assistance is not provided.
In the event of an identified emergency, you may be required, as a term and condition of DPH employment, to assist in meeting the emergency responsibilities of the department.
ADA Statement
DPH is committed to providing access and reasonable accommodation in its services, programs, activities, and employment for individuals with disabilities. To request a reasonable accommodation for the application or interview process, email include DPH-ADA@dph.ga.gov.
DPH is an Equal Opportunity Employer
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Due to the volume of applications received, we are unable to provide information on application status by phone or e-mail. All qualified applicants will be considered,but may not receive an interview. DPH will contact selected applicants to proceed with the application process. Applicants who are not selected will not receive notification.
This position is subject to close at any time once a satisfactory applicant pool has been identified.
BENEFITS
Standard Benefits for Full-Time Salaried Employees
In addition to a competitive salary, we offer a generous benefits package that includes a flexible schedule, training opportunities, health insurance, employee retirement plan (ERS GSEPS), deferred compensation, 13 paid holidays, vacation and sick leave, paid parental leave, dental, vision, long-term care, and life insurance.
Standard Benefits for Part-Time Employees
Part-time employees are eligible to participate in the Georgia Defined Contribution Plan and receive paid parental leave.
Minimum Qualifications:
Bachelor's degree in health care services or related field from an accredited college or university and six (6) years of professional managerial or supervisory experience in health care services; or two (2) years of experience at the lower level Sr Mgr, Health Care (HCM013) or position equivalent.--Note: Some positions may require certification and/or licensure.Equal Employment Opportunity Employer
The State of Georgia does not discriminate based on race, color, national origin, sex, religion, age, disability, or other protected categories in employment or the provision of services.
Qualified applicants may request reasonable accommodation when needed during the application and/or screening process by contacting the appropriate agency Human Resources department.