Provider Payment Strategy Manager

We have an opportunity to join the Alliance as the Provider Payment Strategy Manager in the Payment Strategy Department. 

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Provider Payment Strategy Director, this position:

• Manages the advancement of provider reimbursement methodologies to align with organizational strategies and objectives, including value-based payment, and 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 

ABOUT THE TEAM

The Payment Strategy department ensures the Alliance's payments to our network are adequate to our revenue. We also work to advance our payment methodology in order to achieve the best quality healthcare while reducing costs. 

THE IDEAL CANDIDATE 

• An experienced analytical and collaborative leader, with direct experience in managing provider payment strategies within a managed care setting
• Technically strong, with skill in provider reimbursement modeling, payment structure design and reimbursement strategies
• Strength in leading and mentoring teams while fostering ownership and accountability 
• A collaborative and professional communication style, building productive relationships with internal teams and provider communities

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here. 

• Knowledge of:
• Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers 
• Provider contracting, including language, reimbursement methods, and rates
• Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical and provider data 
• Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), ICD 9/10 and CPT codes, and industry standard groupers, such as ETGs, DRGs, and DCGs 
• Managed care concepts, contracting, policies, and procedures
• Ability to:
  • Develop work plans and workflows and organize and prioritize provider reimbursement activities 
  • Train, mentor, supervise, and evaluate the work of staff, promote an atmosphere of teamwork and cooperation, and motivate staff to achieve goals and objectives
  • Apply analytical and pricing expertise to the evaluation, negotiation, implementation, and maintenance of managed care contracts
  • Technical and non-technical troubleshooting and diagnose and resolve complex problems, including problems that may have multiple variables and may not have obvious solutions 
  • Develop data-driven and outcome-based initiatives to improve business decision making and improve business processes
• Education and Experience:
  • 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, including a minimum of three years of experience in a managed care environment, and a minimum of three years of management, supervisory, or lead experience; (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below. 

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area

Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area