Reimbursement Manager Job at Baptist Health (Florida) (Jacksonville)

Medical Reimbursement Specialist

We are in search of a Medical Reimbursement Specialist to join our team. Station...

Location

United States , Princeton

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 3 years of experience in a similar role
Proficient in benefit functions
Demonstrated expertise in billing functions
Experience in claim administration
Familiarity with collection processes
Ability to handle and resolve medical denials
Comprehensive knowledge of Medicare

Job Responsibility

Analyze and categorize outstanding claims based on payer, denial reason, and claim value
Investigate and take corrective action on unpaid, denied, or underpaid claims
Collaborate with internal teams to obtain missing documentation and expedite claim resubmission
Evaluate common denial reasons and address them accordingly, such as coding errors, medical necessity, and prior authorization
Submit corrected claims and formal appeals as required
Communicate with insurance payers to resolve aged claims and escalate unresolved claims as necessary
Maintain comprehensive records of all payer interactions
Identify the root causes of denials and implement best practices to prevent future issues
Suggest changes to workflow to enhance claim submission accuracy and speed
Conduct training for in-house billing teams on claim recovery strategies

What we offer

medical, vision, dental, and life and disability insurance
eligibility to enroll in company 401(k) plan

Fulltime

Senior Manager, Government Programs - Medicaid

The Senior Manager for Government Programs - Medicaid at Baxter will work to ens...

Location

United States , Saint Paul, Minnesota

Salary:

152000.00 - 209000.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

Bachelor’s degree required
6 plus years in health policy, reimbursement, Medicaid and public health payment programs is required
3 plus years of pharmaceutical/medical device proven experience is required
Proven understanding of Medicaid systems and differences in state operations required
Detailed understanding of state programs, processes, and experience preferred
Established track record of cultivating relationships with Medicaid Administrators, specifically directors, policy managers, and medical directors, through articulate written and verbal communication.

Job Responsibility

Develop relationships with Medicaid Administrators to assist in clarification of state policies and find opportunities for coverage development
Act as the primary contact for Respiratory Health to Government Programs in communications and meetings
Supervise Government Payer requirements & policies to identify potential changes that may impact Respiratory Health’s reimbursement process
Lead resolution of Medicaid payer issues brought up from Patient & Customer Service teams
Advance questions requiring Legal or Compliance guidance related to reimbursement processes to appropriate resource
Participate in industry Trade Associations or State HME / DME Associations
Collaborate with Government Affairs on state lobbying efforts
Analyze government program trends applying internal and external data
Maintain communication with senior management regarding major reimbursement issues
Assist the Coverage Manager on Coverage Expansion strategy development

What we offer

Medical and dental coverage that start on day one
Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan
401(k) Retirement Savings Plan
Flexible Spending Accounts
Educational assistance programs
Paid holidays
Paid time off ranging from 20 to 35 days based on length of service
Family and medical leaves of absence
Paid parental leave

Fulltime

Value Access & Policy Manager

Amgen is hiring a Value & Access Policy Manager/ Associate Manager in Malaysia. ...

Location

Malaysia , Kuala Lumpur

Salary:

Not provided

Amgen

Expiration Date

Until further notice

Requirements

Minimum of 5 years of experience in the pharmaceutical industry
At least 2 years working for a global pharmaceutical company in areas of tender, pricing and access management
Good understanding of Malaysian Healthcare Systems and future outlook
Good understanding of pharma/biotech business model, regulatory and reimbursement processes, compliance guidelines and Health Economics & Outcomes
Computer skills (MS Office programs)
Fluency in English, both oral and written communications
Demonstrate strong communications skills, strategic thinking, and industry knowledge
Outstanding verbal and written communications skills as well as excellent interpersonal skills
Ability to assimilate complex medical knowledge and communicate to non-medical audiences
Sensitivity to diverse groups of people both internal and external with the ability to manage different opinions and perspectives

Job Responsibility

Developing and leading the implementation of drug access and pricing strategy involving government and private healthcare organisations in Malaysia
Work collaboratively with external third-party organizations to align and execute on shared goals across Amgen Malaysia’s product portfolios
Work cross-functionally to ensure the benefits to patients offered by Amgen products can be optimized
Ensure all access initiatives adhere to highest level of integrity and Amgen Values
Develop and implement access strategies for responsible portfolios in Malaysia, including but not limited to pricing, product listing and partnerships
Build long term, substantive relationships with all relevant access stakeholders based on values of trust, respect and transparency so that to enable all aspects of healthcare delivery and access
Support access to medicines by working with HCOs and HCPs on value-based partnerships to help determine the value of innovation and address access barriers
Serve as an internal resource and identify opportunities to maximize HCPs-/HCOs- related projects, and coordinate across functions around key areas of concern for access and reimbursement
Work cross-functionally across teams as a strong partner and collaborator
Monitor the external healthcare environment with respect to drug access and reimbursement

What we offer

Vast opportunities to learn and move up and across our global organization
Diverse and inclusive community of belonging, where teammates are empowered to bring ideas to the table and act
Generous Total Rewards Plan comprising health, finance and wealth, work/life balance, and career benefits

Fulltime

Certified Epic Analyst

Baptist Health is hiring a Certified Epic Analyst to join our team. This is a fu...

Location

United States , Tallahassee

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

Managed Care Contract
Bachelor of Science (non Nursing) Required
EPIC Resolute Hospital Billing Expected Reimbursement Contracts Administration Certified
EPIC Resolute Physician Billing Expected Reimbursement Contracts Administration Certified

Job Responsibility

Accurately load managed care contracts, government contracts and special contracts for Baptist Health hospitals, physicians, and ancillary entities into the Epic system
Test the reimbursement functions and collaborate with managed care plans to ensure timely and accurate contract loads by the managed care plans
Complete necessary steps to operationalize contracts following completion of negotiations

Fulltime

Manager Reimbursement - Accounting

The primary purpose of the Reimbursement Manager is to ensure proper payments ar...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Bachelor's Degree required

Job Responsibility

Prepare and review monthly contractual allowance journal entries and supporting calculations and responsible for proper balances in associated income statement and balance sheet accounts, for multiple facilities
Scope of accounting responsibility includes Medicare, Medicaid, USFHP, CHAMPUS, Blue Cross, Worker's Compensation and Managed Care
Analyze monthly contractual allowance variances, providing detailed explanations for significant fluctuations to Hospital Administration for use during close meetings
Maintain current, correct account analysis' related to program Income Statement and Balance Sheet accounts
Ensure monthly reports are prepared timely and accurately by supporting departmental Associates
Prepare final hospital and home office cost reports, completing comparative analysis of the cost report versus the financial statement and compliance checklist prior to submission, for multiple facilities
Ensure Medicare, Medicaid and CHAMPUS cost reports are submitted by due dates to prevent loss of reimbursement to the facilities
Identify and pursue proper reimbursement methodologies in an effort to receive all reimbursement due based upon Medicare, Medicaid and CHAMPUS Regulations
Coordinate the Medicare Field Audits, ensuring complete, proper and timely information is provided and audit adjustments are reviewed prior to issuance of the settlement
Errors found must be communicated in writing to the Auditors during the audit, to ensure proper settlement and issuance of the Notice of Program Reimbursement

Fulltime

Field Case Manager

Our team members are at the heart of everything we do. At Cencora, we are united...

Location

Canada , Saskatoon; Spruce Lake; Allan; Abbey; Spiritwood West

Salary:

Not provided

Cencora

Expiration Date

Until further notice

Requirements

Registered nurse (RN)
Related degree may be considered (pharmacists, science degrees) or equivalent transferable skills
Experience in public or private third party reimbursement arena or pharmaceutical sales experience, managed care, or clinical support, or related experience an asset
Bilingualism is an asset (requirement for province of Quebec)
Previous Case Manager experience an asset
Basic CCPE an asset
Exceptional customer service and interpersonal skills
Ability to manage multiple tasks and priorities at once
Comprehension of medical terminology
Strong analytical and organizational skills

Job Responsibility

Single point of contact for the program with physicians
Educate physicians and/or their staff on various program services
Provide therapy guidelines to manage physician expectations with respect to reimbursement
Consult patient charts in order to effectively complete necessary paperwork to obtain coverage
Assist MDs in completing Special Authorization (SA) forms, enrolment forms, prescription renewals, and other documentation
Provide ongoing updates to physicians on their patients
Customize current program elements to meet the needs of assigned physicians: adjust based on in-clinic and remote MD needs
Identify areas for risk and foster proactive, continued quality improvement
Work collaboratively with other team members in various roles to coordinate the patient journey
Participate in scheduled physician meetings with sales representatives

What we offer

Medical
dental
vision care
comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness
support for working families, which may include backup dependent care, adoption assistance, infertility coverage, family building support, behavioral health solutions, paid parental leave, and paid caregiver leave
variety of training programs
professional development resources
opportunities to participate in mentorship programs, employee resource groups, volunteer activities

Fulltime

Director, Out-of-Network Contracting

The Director, Out-of-Network Contracting will report directly to the VP of Provi...

Location

United States , New York

Salary:

154600.00 - 236555.00 USD / Year

Healthfirst

Expiration Date

Until further notice

Requirements

Bachelor’s Degree from an accredited institution
10+ years of progressive experience in Managed Care contracting, network management, or related payer functions
Deep expertise in healthcare reimbursement methodologies, including Capitation, APR DRG, MS DRG, APGs, APCs, RBRVS, and Per Diems
Demonstrated success leading enterprise-scale OON contracting strategies with significant financial impact
Experience negotiating complex facility, professional, ancillary, and behavioral health contracts
7+ years of people leadership experience, including leading managers and senior professionals
Strong knowledge of Medicare, Medicaid, and Commercial healthcare regulations and reimbursement structures
Proven ability to influence executive stakeholders and lead cross-functional initiatives

Job Responsibility

Set the enterprise strategy for Out-of-Network contracting, including rate methodologies, provider segmentation, and conversion strategies to bring high-utilization OON providers into the contracted network
Own accountability for OON contracting financial outcomes, including unit cost reduction, medical cost savings, and mitigation of OON spend
Design and govern the operating model for centralized OON contracting across facility, professional, ancillary, and behavioral health providers
Establish and maintain enterprise policies, procedures, and rate guidelines that ensure consistency, compliance, and scalability and in alignment with regulatory requirements and market conditions
Lead and develop a team responsible for negotiating and executing Out-of-Network contracts
Represent Healthfirst in external-facing negotiations with providers and other stakeholders as required
Partner with Finance and Medical Economics to develop savings targets, forecasts, and performance tracking tied to OON contracting activity
Ensure compliance with Medicare, Medicaid, and Commercial regulatory requirements and proactively mitigate contracting and reimbursement risk
Translate regulatory changes into contracting strategy
Consolidate facility, professional, ancillary, and behavioral health OON contracting functions to drive standardization and medical cost savings

What we offer

medical, dental and vision coverage
incentive and recognition programs
life insurance
401k contributions

Fulltime

HR and Plant Administrative Assistant

The HR Administrative Assistant will be primarily responsible for providing huma...

Location

United States , Richmond

Salary:

Not provided

Belden, Inc

Expiration Date

Until further notice

Requirements

Moderate Computer Skills
Must have a working knowledge of a computer and ability to work with the Microsoft Office suite
Must have good communication skills and the ability to work in a collaborative, team environment
Must be able to interpret analytical information to help determine process improvements opportunities
Must be able to use the 5Y tools when performing a root cause analysis
Ability to plan and/or schedule workload to handle peak periods and unexpected situations
Must be able to complete tasks with minimal supervision
Must be able to handle confidential information appropriately
Must be able to comply with Company Attendance Policy

Job Responsibility

Deliver effective human resources administrative support by assisting managers and staff across the entire human resources team
Act as first point of contact for HR-related queries from employees and external partners
Coordination of employee events and external customer visits, spanning all 3 shifts
Perform a variety of employment related administrative functions including, but not limited to: Maintain HR database
Manage departmental purchases
Maintain plant training records
Process E-Verify/I-9s for new hires
Process merit increases for plant and distribution center
Process employee terminations
Manage tuition reimbursement for Belden NA

Reimbursement Manager

Baptist Health (Florida)

Location:
United States , Jacksonville

Category:
Finance

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
January 05, 2026

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