Value-Based Reimbursement Specialist -USA-ID-7958

by

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

Other Posts You May Be Interested In

  • 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

​
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

  • Masters

LICENSES or CERTIFICATIONS

Required

  • None

Preferred

  • None

Leave a Comment

Who we are

Welcome to careers.techlabrepairs.com, the premier platform designed to streamline your job search across the internet. Our objective is clear: to enhance the job-seeking experience by consolidating job listings from various reliable sources into one accessible location, ensuring a wealth of opportunities is just a click away.
In the current fast-paced environment, job hunting can be daunting. With numerous job boards, recruitment firms, and corporate career pages to navigate, identifying the ideal position often becomes a laborious task. This is where we come in. At careers.techlabrepairs.com, we have developed a website that compiles job listings from a diverse array of reputable sources, reducing the time and effort required to find your next career opportunity.

Our Vision
Our vision is to offer job seekers a seamless and efficient pathway to discovering top-tier employment opportunities. Recognizing that each job seeker has unique preferences and requirements, we strive to provide a platform with a comprehensive range of job listings catering to the diverse needs of all professionals.
We advocate for a job search process that is straightforward and accessible. By aggregating listings from leading job boards, corporate career sites, and recruitment agencies, we simplify the process of finding roles that align with your skills, experience, and career aspirations. With careers.techlabrepairs.com, there's no need to jump between different websites—everything you require is right here.

Why Choose Us?
Comprehensive Listings Our platform gathers job listings from trusted sources across the web, ensuring access to a vast array of opportunities. Whether you seek remote work, freelance projects, part-time roles, or full-time positions, we provide options across numerous industries, from technology and healthcare to marketing and finance, ensuring you find the perfect match for your expertise.

User-Friendly Experience
Navigating job listings should be straightforward, not burdensome. Our user-friendly interface facilitates easy searching, filtering, and application processes. Our search functionality allows you to refine listings by location, job type, salary range, and more, enabling swift identification of positions that meet your criteria.

Up-to-Date Listings
We maintain a platform that reflects the latest job openings by regularly updating our listings. This ensures access to fresh job postings, providing you with a competitive advantage in the job market.

Tailored Results
Utilizing advanced algorithms, our platform delivers personalized job recommendations based on your preferences and search history. By understanding your career objectives, we present the most relevant opportunities, helping you find the best positions swiftly.

For Employers & Recruiters
careers.techlabrepairs.com serves not only job seekers but also employers and recruiters, offering a robust platform to showcase job openings to a wide and diverse audience. By posting listings on our site, you can reach a larger pool of qualified candidates, facilitating a quick and effective connection with top talent. Our mission is to assist employers and job seekers in making the perfect match, enhancing the hiring process's efficiency and dynamism.

Our Commitment
At careers.techlabrepairs.com, we are dedicated to making the job search process smoother for everyone. We aim to provide accurate, reliable, and current job listings in a user-friendly environment. Understanding the challenges of job searching, we are here to support you at every stage. Whether embarking on your career journey or seeking advancement, careers.techlabrepairs.com is committed to helping you thrive.

Thank you for choosing us as your trusted partner in job search. We look forward to assisting you in finding the ideal job and advancing your career to new heights.

Disclaimer: Job Posting Sources

Various reliable job search engines, such as Indeed, LinkedIn, ZipRecruiter, CareerBuilder, Monster, Glassdoor, Getwork, Snagajob, and FlexJobs, are the source of the job postings on our platform. Although we make every effort to present accurate and current information, we are unable to guarantee the accuracy, completeness, or dependability of the job postings from these outside sources.

When applying for jobs found on these platforms, users are advised to perform their own due diligence. We are not liable for any errors, omissions, or inaccuracies in the job postings, and neither do we support any particular employer or job posting.

Additionally, please be aware that job listings may change without warning and that some may not be relevant or active at the time of viewing.

Users who access job postings from these outside sources through our platform consent to indemnify us for any liability resulting from the use of such information.