Value-Based Reimbursement Specialist – USA Remote Jobs

JOB SUMMARY

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. 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 on multiple projects and 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
• Ability to adapt engagement strategies to meet market needs

EDUCATION

Required

• Bachelors in Clinical or healthcare industry discipline OR relevant experience and/or education as determined by the company in lieu of bachelor's degree

Preferred

LICENSES or CERTIFICATIONS

Required

Preferred

Language (Other than English):

None

Travel Requirement:

Less than 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Occasionally

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times.  In reputed company with this, reputed company employees must reputed company with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as reputed company data reputed company guidelines established reputed company the Company’s Handbook of Privacy Policies and Practices and Information reputed company Policy. 

Furthermore, it is every employee’s responsibility to reputed company with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$67,500.00

Pay Range Maximum:

$126,000.00

reputed company pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential reputed company may apply for certain locations based upon comparative markets.

reputed company and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law.

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