Value-Based Reimbursement Specialist ID-11249
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.
Part-Time Data Entry, $40/hr, Remote, College Student Friendly Live Chat Support, $50/hr, Remote, Night Shift, No Degree Remote Phone Support, $40/hr, Night Job, College Student Virtual Assistant, $40/hr, Evening, Remote, No Degree Virtual Assistant, No Degree, $40/hr, Remote, Part-Time Remote Moderator, $40/hr, Weekend, No Degree, Part-Time Remote Data Entry, $35/hr, No Experience, Evening/Night Job Remote Data Entry, $40/hr, College Student Friendly, Part-Time Virtual Assistant, No Experience, $42/hr, Remote, Part-Time Virtual Assistant, $40/hr, No Experience, Remote, Night Job Data Entry, $40/hr, Part-Time, Remote, Weekend Job Entry-Level Remote Data Entry, $35/hr, Evening Job Live Chat Support, $35/hr, Remote, No Experience Required Virtual Assistant, $42/hr, Remote, Weekend, Entry Level Data Entry, No Degree, $45/hr, Part-Time, Remote Job Virtual Assistant, Remote, $42/hr, Weekend, No Experience Remote Moderator, $40/hr, Weekend, No Degree, Part-Time Phone Job, $45/hr, Remote, Night Shift, No Degree Remote Moderator, $40/hr, Weekend, No Degree, Part-Time Virtual Assistant, $42/hr, Evening, Remote, No Degree Virtual Assistant, $40/hr, Remote, Night Shift, No Experience Remote Live Chat, $35/hr, Part-Time, Evening/Night Job Weekend Customer Support, $40/hr, Remote, College Student Data Entry, $35/hr, Remote, Evening Job, College Student Virtual Assistant, $40/hr, Remote, No Degree, Night Job Live Chat Support, $50/hr, Remote, No Experience Required Weekend Customer Support, $40/hr, Remote, College Student Remote Customer Support, $40/hr, Night Job, No Experience Remote Data Entry, $40/hr, Part-Time, No Degree Required Remote Phone Job, $42/hr, Part-Time, No Experience Required Data Entry, Remote, $40/hr, Evening Job, No Degree Virtual Assistant, $40/hr, Remote, Night Shift, No Experience Remote Moderator, $40/hr, Weekend, No Degree, Part-Time Virtual Assistant, $40/hr, Weekend, Remote, No Experience Remote Data Entry, $40/hr, College Student Friendly, Part-Time Remote Data Entry, $45/hr, No Degree, Night Shift Virtual Assistant, $50/hr, Evening, Remote, College Student Remote Live Chat, $50/hr, College Student, No Experience Remote Phone Job, $42/hr, Part-Time, No Experience Required Data Entry, $40/hr, Remote, Evening, No Experience Required Data Entry, No Degree, $40/hr, Part-Time, Remote Job Customer Support, $50/hr, Remote, Evening/Night Job, No Degree Virtual Assistant, $42/hr, Remote, No Experience, Evening Customer Support, $50/hr, Remote, Evening/Night Job, No Degree Virtual Assistant, $42/hr, Remote, No Experience, Evening Virtual Assistant, $50/hr, Evening, Remote, College Student Remote Moderator, $50/hr, No Degree, Weekend, Part-Time Phone Job, $35/hr, Remote, No Degree, Part-Time, Weekend Customer Support, $42/hr, Weekend Job, Remote, No Degree Virtual Assistant, Remote, $45/hr, Evening, No Experience Live Chat Support, Remote, $42/hr, Night Shift, College Student Virtual Assistant, Remote, $40/hr, Evening, No Experience Virtual Assistant, $40/hr, Remote, No Degree, Night Job Entry Level Phone Job, $42/hr, Remote, No Degree Required Virtual Assistant, $40/hr, Remote, No Experience, Night Job Virtual Assistant, Remote, $45/hr, Evening, No Experience Remote Phone Job, $40/hr, No Degree, College Student Friendly Phone Job, $40/hr, Remote, Night Shift, No Degree Data Entry, $40/hr, Remote, Evening, No Experience Required Remote Phone Job, $45/hr, Part-Time, No Degree Required Remote Moderator, $45/hr, No Degree, Weekend Job, Part-Time Virtual Assistant, $35/hr, Weekend, No Degree, Remote Remote Customer Support, $45/hr, Part-Time, College Student Virtual Assistant, $35/hr, Weekend, No Degree, Remote Live Chat Support, $40/hr, Remote, Entry Level, Part-Time Data Entry, $40/hr, Evening Job, No Experience, Remote Virtual Assistant, $42/hr, Remote, No Experience, Evening Remote Data Entry, $40/hr, Part-Time, College Student Job Entry-Level Remote Data Entry, $35/hr, Evening Job Evening Virtual Assistant, Remote, $40/hr, No Experience Evening Virtual Assistant, Remote, $45/hr, No Experience Weekend Customer Support, $42/hr, Remote, College Student Live Chat Support, $40/hr, Remote, Entry Level, Part-Time Live Chat Support, $35/hr, Remote, No Experience Required Remote Live Chat, $50/hr, Part-Time, Evening/Night Job Virtual Assistant, No Degree, $40/hr, Remote, Part-Time Weekend Customer Support, $40/hr, Remote, College Student Phone Support, Remote, $42/hr, Evening/Night Shift Customer Support, $50/hr, Remote, Evening/Night Job, No Degree Entry Level Phone Job, $40/hr, Remote, No Degree Required Virtual Assistant, Remote, $45/hr, Evening, No Experience Remote Customer Support, $50/hr, Night Shift, No Degree Virtual Assistant, $40/hr, Remote, No Experience, Night Job Phone Support, $35/hr, Weekend, Remote, No Experience Data Entry, $45/hr, Remote, Evening, No Experience Required Data Entry, No Degree, $40/hr, Part-Time, Remote Job Virtual Assistant, No Experience, $40/hr, Remote, Part-Time Evening Virtual Assistant, Remote, $45/hr, No Experience Live Chat Support, $42/hr, Weekend, Remote, No Degree Remote Phone Support, $45/hr, Evening, No Experience Required Remote Moderator, $40/hr, No Degree, Weekend Job, Part-Time Remote Moderator, $40/hr, Part-Time, Weekend, No Degree Live Chat Support, $45/hr, Weekend, Remote, College Student Remote Phone Job, $40/hr, Part-Time, No Degree Required Remote Customer Support, $40/hr, No Degree, Evening Job Remote Phone Job, $40/hr, Night Shift, College Student Friendly Virtual Assistant, $35/hr, Part-Time, Remote, Weekend Job Phone Job, $40/hr, Remote, Night Shift, No Degree Remote Moderator, $40/hr, College Student, Weekend Job Remote Phone Job, $40/hr, Night Shift, College Student Friendly Virtual Assistant, Remote, $40/hr, Weekend, No Experience Remote Phone Support, $45/hr, Night Job, College Student Virtual Assistant, $40/hr, Remote, Night Shift, No Experience Phone Job, $50/hr, Remote, Part-Time, College Student Remote Phone Job, $35/hr, College Student, Night Shift Data Entry, Remote, $40/hr, Night Shift, No Degree Data Entry, No Degree, $40/hr, Part-Time, Remote Job Data Entry, Remote, $42/hr, Evening Job, No Degree Data Entry, $50/hr, Night Job, No Degree, Remote
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 continuous improvement models. Lead or support key strategic initiatives across Enterprise and Markets and Provider Transformation for the Organization’s value-based reimbursement programs and continuous 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 within 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, gain 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 complex issues critical to the success of the initiative and play a role in shaping the culture and skill 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 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
