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Value-Based Reimbursement Specialist ID-8216

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

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all 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 all times.  In connection with this, all employees must comply 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 all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply 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

 

Base 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 Highmark may apply for certain locations based upon comparative markets.

 

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

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