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Director, OPL Federal Health Program Reimbursement
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- Establishes and communicates policy to Plans by way of authorship of OPL specific content to the FEP Administrative Policy Manual (APM) and Benefits Policy Manual (BPM), which are published to Plans online via a Plan portal and as needed, via Special Memorandum
- Responds to all Plan and vendor OPL inquiries including ones submitted via FEP Hub. Directs and executes activities for the internal Medicare Primary Denial Workgroup to include initiation of new central claims processing controls, in response to OPM and Office of Inspector General (OIG) audit findings, and management of the long-term effectiveness of those changes
- Reviews, approves, and manages analysis activities on Medicare Secondary Payer (MSP) federally mandated group health reporting for FEP membership, under the Section 111 Exchange, by the FEP Operation Center (FEPOC) and maintains effective business relationship with Section 111 governmental counterparts to address policy/reporting issues
- Develops and maintains business relationships, in support of effective policy guidance development and the practical execution of that policy, with CAQH leadership and payer participants, federal agency partners on Medicare (HHS-CMS), Workers Compensation (DOL) and on reimbursement activities with IHS, DoD and VA
- Develops and maintains effective business relationships, in support of FEP OPL business policy interests and accurate payment, with external federal agencies (CMS, DOL, IHS, DoD, VA) staff, CAQH and internal groups/cross-functional teams
Expired 13 days agoInactive Job
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