Reimbursement Economics Analyst

Company :

Job Description : 

JOB SUMMARY

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 and external customers, including but not limited to VBR team members, operations, actuary, provider relations, strategic integration and advanced analytics and reporting. The incumbent leads the development of VBR models/initiatives, coordinating with each related business segment, and functional area partners’ work The focus of the work is the creation of a comprehensive suite of reimbursement models that align with enterprise goals and strategic objectives across the enterprise, including both AHN and the Health Plan. The development of VBR models should consider 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.  Collaborates with internal partners to identify new opportunities for VBR innovation.  Manages the organizational matrix – specifically business partners and their respective support functions who have accountability to implement initiatives in the portfolio. The incumbent reports into the Enterprise and specifically with the Living Health Solution team.  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 (SVPs, VPs, Directors, etc.) in formal and informal situations, and strong demonstration of analytical, communicative, and influencing skills.

ESSENTIAL RESPONSIBILITIES

• Develop and foster relationships across the enterprise.  Provide analytical and consultative support to a broad spectrum of internal customers and external business partners.
• Identify innovative approaches to reimbursement that capitalize on opportunities and market inefficiencies and create value for the organization across cost, utilization and quality.
• Lead the maintenance/maturation of in-market VBR models and the development of new VBR models partnering with internal stakeholders and aligning to broader organizational strategies and goals. 
• Work with operations, reimbursement, actuary, and analytic teams to ensure opportunities for VBR model development are based upon empirical evidence and internal; alignning with the strategic roadmap to ensure maximum flexibility and speed to market.
• Communicate recommendations for VBR strategies to leadership across the enterprise supporting organizational goals and objectives.  
• 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 enterprise business and functional area partners to develop a pipeline of new VBR 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 and with other strategic partners.  Lead in a matrixed work environment and help drive a culture change from “reporting the past” to “creating the solutions for future.”Collaborate with senior and executive leadership on model builds and program design. 
• Other duties as assigned or requested.

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EDUCATION

Required

• Bachelor's Degree in Business, Math, Economics, Health Administration or related field

Substitutions

• Six years relevant experience in lieu of bachelors degree

Preferred

• Master's Degree in Business, Math, Economics, Health Administration or related field

EXPERIENCE

Required

• 3 years in cross-functional project team, strategy development role, and/or healthcare industry role

Preferred

• 3 years in Business Analyst, Business Intelligence, Finance/Analytics

LICENSES AND CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• Strong strong verbal/written communication skills (including executive quality presentations)
• Analysis of business problems/needs
• Analytical skills
• Collaborative problem solving
• Creative thinking
• Mathematics proficiency
• Strategic thinking and development

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Language (Other than English)

None 

Travel Required

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

Occasionally

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

Never

Physical work site required 

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

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

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. 

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

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 any category protected by applicable federal, state, or local law.

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