(USA) Senior Manager I, Billing - Payment & Reconciliation

Position Summary...

What you'll do...

Ensures compliance with laws and regulations by

• researching changes to federal, state, and local laws and regulations impacting insurance payment of medical bills
• ensuring changes in state reporting requirements, periodic fee schedules, and applicable laws and regulations are applied to bill review process and procedures
• evaluating auditing results to ensure audit forms measure the desired quality results
• modifying the auditing process as needed in response to regulatory changes
• building and maintaining relationships with other bill processing teams, state agencies, the legal department, and bill review suppliers to clarify regulations or implement systematic changes required for compliance
• evaluating vendor processors quality audit results, providing feedback on results to vendor processors, and creating action plans to correct deficiency; and ensuring regulatory certifications for state and federal utilization and bill review are obtained.
  

Partners with senior management to plan and analyze business performance by

• collaborating with internal and external key stakeholders for relevant information
• identifying gaps between business goals and stated corporate objectives
• communicating and presenting immediate and future projections, results, risks, and needs to various levels of leadership
• providing feedback to senior management regarding assumed level of risk
• supporting business unit budget process and strategic business plans
• providing insight on relevant historical trends, expected future events, and retail trends.

Manages and maintains vendor contracts by

• holding vendors accountable for delivering contracted services
• ensuring contract language meets business and compliance requirements
• monitoring workflow and changing it to meet vendor requirements to obtain discounted services
• ensuring claims team complies with contract requirements.
  

Serves as subject matter expert by

• educating internal teams about bill review process and system changes
• providing supporting information and education related to litigation of bill review to defense attorneys
• analyzing bill review litigation trends with adjusting team’s legal department to develop solutions for implementation
• collaborating with third party administrators to improve processes
• drafting letters and explaining review statements for multiple states
• educating team and vendor processors on pre-litigation best practices
• participating and leading special projects to enhance bill payment processes.
  

Oversees the continuous improvement of operational and system processes for government and commercial billing by

• conducting program evaluations
• assessing past, current, and future parameters of programs
• assessing audit requests, billing requirements, reimbursements, and formulary guidelines
• engaging all required stakeholders
• defining the appropriate action plan
• following up with stakeholders to ensure accuracy and completeness in the billing process.

Drives the execution of multiple business plans and projects by

• identifying customer and operational needs
• developing and communicating business plans and priorities
• removing barriers and obstacles that impact performance
• providing resources
• identifying performance standards
• measuring progress and adjusting performance accordingly
• developing contingency plans
• demonstrating adaptability and supporting continuous learning.

Provides supervision and development opportunities for associates by

• selecting and training
• mentoring
• assigning duties
• building a team-based work environment
• establishing performance expectations and conducting regular performance evaluations
• providing recognition and rewards
• coaching for success and improvement
• ensuring diversity awareness.

Promotes and supports company policies, procedures, mission, values, and standards of ethics and integrity by

• training and providing direction to others in their use and application
• ensuring compliance with them
• utilizing and supporting the Open Door Policy.

Ensures business needs are being met by

• evaluating the ongoing effectiveness of current plans, programs, and initiatives
• consulting with business partners, managers, co-workers, or other key stakeholders
• soliciting, evaluating, and applying suggestions for improving efficiency and cost-effectiveness
• participating in and supporting community outreach events.

#LI-MF4

Live our Values

Culture Champion

• Models the Walmart values to foster our culture; holds oneself and others accountable; and supports Walmart’s commitment to communities, social justice, corporate social responsibility, and sustainability; maintains and promotes the highest standards of integrity, ethics and compliance.

Servant Leadership

• Acts as an altruistic servant leader and is consistently humble, self-aware, honest, and transparent.

Embrace Change

Curiosity & Courage

• Demonstrates curiosity and a growth mindset; fosters an environment that supports learning, innovation, and intelligent risk-taking; and exhibits resilience in the face of setbacks.

Digital Transformation & Change

• Seeks and implements continuous improvements and encourages the team to leverage new digital tools and ways of working.

Deliver for the Customer

Customer Focus

• Delivers expected business results while putting the customer first and consistently applying an omni-merchant mindset and the EDLP and EDLC business models to all plans.

Strategic Thinking

• Adopts a holistic perspective that considers data, analytics, customer insights, and different parts of the business when making plans and shaping the team’s strategy.

Focus on our Associates

Diversity, Equity & Inclusion

• Identifies, attracts, and retains diverse and inclusive team members; builds a high-performing team; embraces diversity in all its forms; and actively supports diversity goal programs.

Collaboration & Influence

• Builds strong and trusting relationships with team members and business partners; works collaboratively and cross-functionally to achieve objectives; and communicates with energy and positivity to motivate, influence, and inspire commitment and action.

Talent Management

• Creates a discipline and focus around developing talent, promotes an environment allowing everyone to bring their best selves to work, empowers associates and partners to act in the best interest of the customer and company, and regularly recognizes others’ contributions and accomplishments.

Minimum Qualifications...

Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.

Preferred Qualifications...

Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications.

Primary Location...