Provider Payment Strategy Manager

Summary

Join the Central California Alliance for Health as the Provider Payment Strategy Manager in the Payment Strategy Department. This role involves managing the advancement of provider reimbursement methodologies, evaluating the feasibility of reimbursement strategies, and providing management oversight to the provider reimbursement function. The ideal candidate is an experienced analytical and collaborative leader with direct experience in managing provider payment strategies within a managed care setting. Responsibilities include supervising staff, applying analytical and pricing expertise to managed care contracts, and developing data-driven initiatives. A bachelor's degree and eight years of relevant experience, including three years in managed care and three years in management, are required. The position offers a hybrid work environment and a competitive salary.

Requirements

• 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

Responsibilities

• 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

Preferred Qualifications

• 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

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