Job Description

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

Responsible for Medica's Reimbursement Policies, including annual maintenance, implementation, research, drafting and presenting policy recommendations for committee vote and coordination of claims system changes to support claim payment accuracy. Performs other duties as assigned.

Key Accountabilities

• Collaborate closely with network management and configuration to troubleshoot claims issues and update systems to resolve complex issues
  
  
• Present insights and recommendations in a way that enables leaders to make confident, data-informed decisions
  
  
• Serve as subject matter expert in reimbursement policy for all lines of business
  
  

Required Qualifications

• Bachelor's degree or equivalent experience in a related field
• 5+ years of work experience beyond degree

Preferred Qualifications

• Advanced Excel skills
• Coding certification strongly preferred: CPC, CPC-P, COC, RHIT, CSS (preferred someone credentialed in facility coding)
• Function as an SME for reimbursement policies
• Able to analyze and translate data (to determine financial impact) and develop recommendations
• Ability to prepare and develop diverse information into effective presentations
• Experience leading/facilitating process improvement teams

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, Omaha, NE, or St. Louis, MO.

The full salary grade for this position is $62,700 - $107,500. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $62,700 - $94,080. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

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