Reimbursement Economics Consultant

Job ID: J114147
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Jan 23, 2018

Share:

Description

JOB SUMMARY

This job supports the Organization's Advanced Value Based Reimbursement Programs Team. The incumbent works closely with management and other stakeholders to develop, coordinate, and manage complex and advanced analysis accompanying existing and new reimbursement models, as well as provides analysis in the development and support of VBR projects and information required to make effective business decisions, and recommend innovative approaches to VBR models and programming. Serves as a liaison and consultant among numerous internal customers, including but not limited to VBR team members, operations, actuary, and advanced analytics and reporting. The incumbent serves as the key link between the design and analytical work in support of VBR initiatives, each related business segment, and functional area partners’ work, with a focus on:  The creation of a comprehensive suite of reimbursement models that align with enterprise goals and strategic objectives across multiple areas within the enterprise and at AHN;
Infrastructure and process development to link medical economic related analytics (trend reporting, medical cost, conditions, etc.) with business partner actions, including progress and impact; Function as point person for all business segment medical economic analytics. Manages the organizational matrix – specifically business partners and their respective support functions who have accountability to implement initiatives in the portfolio.  There will also be significant emphasis placed on frequent and meaningful interactions with business segment and functional department executive/senior leadership to ensure that new reimbursement initiatives and existing program improvements are identified and executed in a timely manner.  This will require engagement with Health Plan Management  and Executives(SVPs, VPs, Directors, etc.) in formal and informal situations, and strong demonstration of analytical, communicative, and influencing skills.

ESSENTIAL RESPONSIBILITIES

  • Provide consultative guidance to business partners, both internal and external, around data driven solutions in regards to our Advanced Value Reimbursement Programs. 
  • Partner with reimbursement, actuary, and analytic teams to drive operational capabilities that are built in sync with the strategic roadmap to ensure maximum flexibility and speed to market.
  • Lead the oversight and monitoring of the Health Plan’s “Creating Customer Value” operating margin improvement effort, driving cross-functional team work efforts to identify, design, implement and monitor initiatives that improve the Organization’s revenue, claims and administrative expenses:
  • Use medical economics experience and knowledge to facilitate idea generation and quantification of savings initiatives (areas of focus include provider contracting, utilization management, care management, risk adjustment, operational efficiencies, product design, etc.).
  • Provide timely insight into claim cost drivers for the business segment leaders and identification of new improvement opportunities.
  • Understand the larger medical cost picture, and create processes to identify and quantify interactions and dependencies of the different initiatives.  
  • Consult with business partners and lead the interpretation of raw data, statistical results or otherwise complex compiled information, identify follow-up action items and prepare written reports and/or oral presentation of findings to internal and external audiences
  • Provide superior ability to analyze and forecast effects and implementation of beneficial but complex financial arrangements with new vendor business partners.
  • Develop and implement improved infrastructure and processes to provide Health Plan and Enterprise management with regular performance scorecards highlighting initiative implementation successes, accountability, and “capture” of initiative benefits, activity, progress and identification of barriers.
  • Consistently work with Health Plan business and functional area partners to develop a pipeline of new initiatives, seeking to achieve our multi-year financial improvement targets. 
  • Serve as the subject matter expert for the enterprise on issues related to value-based reimbursement, including impact to organizational strategic efforts and new programs in development at AHN. 
  • Lead in a matrixed work environment: Drive a culture change from “reporting the past” to “creating the solutions for future.”
  • Collaborate and consult with senior and executive leadership on model builds and program design.  This will require strong communication skills (verbal and executive quality presentations).
  • Other duties as assigned.

EDUCATION

Required

  • High School/GED
  • Bachelor's Degree

Substitutions

  • None

Preferred

  • Bachelor's Degree in Actuarial Science, Mathematics, Economics, or Health Administration
  • Master's Degree

EXPERIENCE

Required

  • 5 - 7 years in the Healthcare Industry
  • 5 - 7 years in Cross-Functional Project Teams
  • 5 - 7 years in Data Analytics

Preferred

  • 5 - 7 years as a Business Analyst
  • 5 - 7 years in Finance

LICENSES AND CERTIFICATIONS

Required

  • None

Preferred

  • None

SKILLS

  • Analysis of business problems/needs
  • Analytical Skills
  • Collaborative Problem Solving
  • Creative Thinking
  • Innovation
  • Oral & Written Communication Skills
  • Strategic Thinking
  • Presentation Delivery

Language Requirement (other than English)

None

Travel Requirement

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Never

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Does Not Apply

Lifting: 10 to 25 pounds

Does Not Apply

Lifting: 25 to 50 pounds

Does Not Apply

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 position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

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 their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

Share:

Interested in working at the Highmark Health enterprise?
Take the first step by joining our Talent Network today!

Join Our Talent Network

Similar Jobs

Clinical Transformation Consultant-Government (Central PA)

Home, PA, United States
Provider Services

Post Acute Network Performance Manager

Pittsburgh, PA, United States
Provider Services

Manager PIM Provider Maintenance

Pittsburgh, PA, United States
Provider Services

Provider Partnerships Consultant

Camp Hill, PA, United States
Provider Services

Clinical Transformation Consultant - Specialist (Central PA)

Home, PA, United States
Provider Services

Director, Provider Partnerships - Penn State Health

Camp Hill, PA, United States
Provider Services

Director Integrated Provider Partnerships

Camp Hill, PA, United States
Provider Services

Reimbursement Economics Analyst

Pittsburgh, PA, United States
Provider Services

Manager, Network Development

Pittsburgh, PA, United States
Provider Services

Director, Population Health

Pittsburgh, PA, United States
Provider Services

Clinical Transformation Consultant-Specialist (Western PA)

Home, PA, United States
Provider Services

Manager, Value-based Reimbursement, Strategy & Innovation

Pittsburgh, PA, United States
Provider Services

Population Health Performance Specialist

Pittsburgh, PA, United States
Provider Services

Clinical Transformation Consultant - Hospital for Central PA

Home, PA, United States
Provider Services

Provider Account Liaison

Camp Hill, PA, United States
Provider Services

Reimbursement Economics Consultant

Pittsburgh, PA, United States
Provider Services