job

We have an opportunity to join the Alliance as a Lead Payer Analytics Consultant in the Payment Strategy Department.

There are two positions that can be filled remotely for those living in California.

WHAT YOU’LL BE RESPONSIBLE FOR
Reporting to the Provider Payment Strategy Director, this position:

-Functions as a strategic consultant to Alliance executive leadership in the areas of complex managed care payer financial modeling and statistical analysis to evaluate the feasibility of payer reimbursement methodologies
-Advises Alliance executive leadership on organizational decision making through the performance of complex financial analysis to support successful payer reimbursement outcomes
-Acts as subject matter expert and collaborates with internal and external stakeholders to achieve payer reimbursement objectives
-Acts as a subject matter expert and lead to subordinate 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 lead, with direct experience with complex medical payor modeling
Technically strong, with skill in provider reimbursement modeling, payment structure design and reimbursement strategies
A collaborative and professional communication style, building productive relationships supporting multiple stakeholders
Experience with Medicare and/or Medi-Cal (Medicaid) a plus

WHAT YOU’LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements please view the attached link.

Knowledge of:
-Methods and techniques of financial modeling and analysis
-Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers
-Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types
-Healthcare financial statements and accounting principles
-Methods and techniques of developing and delivering data management strategies that support contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations
-National standards for fee-for-service and value-based provider reimbursement methodologies, including risk-sharing models

Ability to:
-National standards for fee-for-service and value-based provider reimbursement methodologies, including risk-sharing models
-Demonstrate strong analytical, critical thinking, and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action
-Be a technical resource, provide guidance related to area of assignment, and explain related regulations, processes, and programs
-Lead, train, mentor and motivate staff, and promote an atmosphere of teamwork and cooperation
-Produce organized, accurate, and detail-oriented work in a fast-paced environment and under the pressure of deadlines

Education and Experience:
-Bachelor’s degree in Business Administration, Accounting, Finance, Healthcare, or a related field
-A minimum of eight years of experience performing financial healthcare reimbursement analysis (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.

Position Description »