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Role Description

This role involves joining the Alliance as the Provider Payment Strategy Manager in the Payment Strategy Department. This is a Defined Term position, which is designated by the Alliance and is a position of limited duration.

• Manages the advancement of provider reimbursement methodologies to align with organizational strategies and objectives, including value-based payment.
• Advises executive leadership regarding the feasibility of various strategies and methodologies.
• Utilizes a variety of methods and models to evaluate the feasibility of reimbursement methodologies.
• Provides management oversight and guidance related to the provider reimbursement function.
• Acts as a subject matter expert and provides guidance on departmental operations.
• Manages, supervises, mentors, and trains assigned staff.

Qualifications

• Bachelor’s degree in Finance, Economics, Accounting, Health Care or a related field.
• A minimum of eight years of experience performing provider reimbursement activities and/or provider payment strategy activities.
• A minimum of three years of experience in a managed care environment.
• A minimum of three years of management, supervisory, or lead experience.
• A Master’s degree may substitute for two years of the required experience.

Requirements

• Knowledge of principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types.
• Knowledge of provider contracting, including language, reimbursement methods, and rates.
• Knowledge of healthcare industry specific terms and healthcare related data types and structures.
• Knowledge of data modeling techniques and business analytical and data mining tools, including SQL.
• Knowledge of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS).
• Knowledge of managed care concepts, contracting, policies, and procedures.
• Ability to develop work plans and workflows and organize and prioritize provider reimbursement activities.
• Ability to train, mentor, supervise, and evaluate the work of staff.
• Ability to apply analytical and pricing expertise to the evaluation, negotiation, implementation, and maintenance of managed care contracts.
• Ability to perform technical and non-technical troubleshooting and diagnose and resolve complex problems.
• Ability to develop data-driven and outcome-based initiatives to improve business decision making and improve business processes.

Benefits

• Medical, Dental and Vision Plans.
• Ample Paid Time Off.
• 12 Paid Holidays per year.
• 401(a) Retirement Plan.
• 457 Deferred Compensation Plan.
• Robust Health and Wellness Program.
• Onsite EV Charging Stations.