Job Description :
This job supports Highmark Health’s Value-Based Reimbursement, Strategy & Innovation Team. The incumbent works closely with management and other stakeholders to develop, coordinate, and manage analysis accompanying existing and new reimbursement models, as well as provide 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 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 and infrastructure and process development to link medical economic related analytics (trend reporting, medical cost, conditions, etc.) with business partner actions, including progress and impact. Functions 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.
- Develop and foster relationships across the enterprise. Provide analytical and consultative support to a broad spectrum of internal customers and external business partners. Work with reimbursement, actuary, and analytic teams to ensure operational capabilities are built in sync with the strategic roadmap to ensure maximum flexibility and speed to market.
- Coordinate 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.
- Provide assistance and, depending on skill and experience, lead with interpretation of raw data, statistical results or otherwise compiled information, identify follow-up action items and prepare or assist in the preparation of 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.
- Help 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 a resource for the enterprise on issues related to value-based reimbursement, including impact to organizational strategic efforts and new programs in development at AHN.
- Other duties as assigned.
- Bachelor’s Degree
- 1 – 3 years in the Healthcare Industry
- 1 – 3 years in Data Analytics
- 0 – 1 year working on a Cross-Functional Project team
- Bachelor’s Degree in Actuarial Science, Mathematics, Economics or Health Administration
- 1 – 3 years as a Business Analyst
- 1 – 3 years in Business Intelligence
- 1 – 3 years in Finance
- Analysis of business problems/needs
- Analytical Skills
- Collaborative Problem Solving
- Creative Thinking
- Mathematics Profiency
0% – 25%
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