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Value-Based Reimbursement Specialist ID-5906

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 continuous 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 within data analytics and infrastructure to support the creation, optimization, and maintenance of self-service resources for providers, entities, and health systems within these programs. Works on multiple projects and has exposure to all parts of the Organization, and will play a supportive role in planning, communicating, and managing the market strategy.

 

ESSENTIAL RESPONSIBILITIES

 

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 revenue 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 Sigma, TQI, TQC or other quality management certification.
  • Experience  in health plan provider network performance management, population health management, continuous improvement, or provider engagement models
  • Experience influencing change in complex organizational systems.

 

​SKILLS

  • Must be able to effectively resolve issues and problems across all 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 integrity, uncompromising professionalism, diplomacy and conflict management
  • Basic project management skills
  • Proactive in driving change and continuous 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
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