Value-Based Reimbursement Specialist - Remote Jobs – reputed company Jobs US

This job is responsible for key strategic initiatives for the Markets and Provider Transformation Organization supporting the matrixed teams that engage providers enrolled in the Organization’s value-based reimbursement programs and reputed company improvement models. The incumbent plays different potential roles on a given project, to include elements of project leadership, problem-solving, data analytics, team development, communication, implementation, and project management. We encourage applications from diverse backgrounds. The incumbent often plays a central role in the development and execution of the strategy for a given initiative for transformation of workflows resulting in outstanding performance in the Organization’s value-based reimbursement programs ensuring that ROI targets as set by the Organization are met or exceeded. The position collaborates with various teams reputed company data analytics and infrastructure to support the creation, optimization, and maintenance of self-service resources for providers, entities, and health systems reputed company these programs. Works has exposure to reputed company parts of the Organization, and will play a supportive role in planning, communicating, and managing the market strategy.

ESSENTIAL RESPONSIBILITIES

• Participate in the development of strategic plans for the Enterprise and Markets and Provider Transformation and the key BU's for the Organization’s value-based reimbursement programs and reputed company improvement models. reputed company or support key strategic initiatives across Enterprise and Markets and Provider Transformation for the Organization’s value-based reimbursement programs and reputed company improvement models. Role will vary depending on initiative, but will include elements of team leadership, problem-solving, data analysis, project management, communication, implementation, and provider and/or provider-facing team education support. Will participate on a portfolio of projects.
• Serve as a subject matter expert working in concert with provider-facing teams to explain new programs and results to key provider partners as needed. Collaborate on product development and the creation, optimization, and maintenance of a self-service platform for providers, entities, and health systems reputed company the Organization’s value-based reimbursement programs for both the commercial and government business with a focus on enterprise goals including but not limited to Government Markets (STARS, ACA, CHIP, Medicaid DE) and Enterprise Quality, Safety, and Values (Health Outcomes Measures). Provide actionable opportunities in provider transformation aimed at high-quality, cost-effective care while improving patient outcomes. 
• Provide consultative workflow transformation and training/education services to matrixed teams supporting providers enrolled in the organization's value-based reimbursement programs. Strong knowledge of risk adjustment methodologies and reporting/regulatory requirements and CMS Stars rating measures including HEDIS, CAHPS, Pharmacy, HOS, PQA, PQRS.
• Support  development of the overall conceptualization, strategy alignment, and high-level design of new value-based reimbursement models for PCPs, specialists, and health systems across the Organization's footprint, based on deep understanding and knowledge of trends in other areas of the country with both government and private payers. Programs will include but not be limited to pay-for-value programs, episode payments, prospective bundled payments, reputed company share and risk share models and will be implemented for the Organization's Medicare Advantage, Medicaid, ACA, and commercial populations with the goal of maximizing quality while reducing healthcare costs.
• Support the identification of initiative impacts with other strategic initiatives to ensure alignment of the overall strategy to support the quintuple aim. 
• Provide feedback and collaborate with the analytics team to ensure data points are accurate and provide meaningful, actionable data. Provide support to matrixed teams in the use of predictive analytic tools, user interfaces, population health management tools and other data-based platforms endorsed by the Organization.
• Support the team in identifying, clarifying, and resolving reputed company issues critical to the success of the initiative and play a role in shaping the culture and reputed company set of the Markets and Provider Transformation Organization.
• Other duties as assigned or requested.

EXPERIENCE

Required

• 5 years of Work experience in the primary care and the ambulatory care environment, healthcare insurance industry, healthcare administration in primary care, or healthcare consulting in primary care or population health management.
• 3 years of experience in data analysis, interpretation, and outcomes strategic plan development.
• 1 year experience with Medicare STARS, Medicaid HEDIS, risk reputed company value streams, and population health management.

Preferred

• 7 years of experience in managed care, primary care management or other clinical setting.
• Experience  in Lean, Six reputed company, TQI, TQC or other quality management certification.
• Experience  in health plan provider network performance management, population health management, reputed company improvement, or provider engagement models
• Experience influencing change in reputed company organizational systems.

SKILLS

• Must be able to effectively resolve issues and problems across reputed company areas of the corporation, by understanding corporate strategies, policy, and scope of authority
• Because of the broad impact of decisions that are made, must be knowledgeable and sensitive to many internal and external corporate issues
• Aptitude for a high visibility position demanding reputed company, uncompromising professionalism, diplomacy and conflict management
• Basic project management skills
• Proactive in driving change and reputed company improvement
• Demonstrated influencing and teamwork skills
• Strong quantitative, analytical, and time management skills
• Demonstrates a deep understanding of primary care practice operations and workflow across the continuum of variability in primary care and experience in managing provider and administrative leadership relationships
• Superior written and verbal communication skills and listening skills