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VP Provider Reimbursement & Analytics

Company: Medica Services Company LLC
Location: Minnetonka
Posted on: April 5, 2021

Job Description:

If you are a job seeker with a disability and require a reasonable accommodation to apply for one of our jobs, you will find the contact information to request the appropriate accommodation by visiting the following page: Description The position provides strategic thinking, development, and direction to the design and implementation of Medica's provider value based payment strategies and business plans. This position leads the Provider Analysis & Reporting function, which is responsible for unit cost management, provider contract modeling, fee schedule development and maintenance, identification and implementation of provider reimbursement related savings initiatives, and other provider reimbursement activities. The position leads efforts to measure, track, report, and analyze ACO, care-system, and overall provider performance. Working closely with Key leaders, including the Chief Actuary, Business Segments leaders, and Operations, this role is responsible for the development and implementation of innovative value-based reimbursement models and risk-share arrangements. The position also works closely with Operations leadership to develop and coordinate the company's provider reimbursement policies. The position functions as the organization's expert on provider payment and risk-sharing methodologies. --Qualifications:

  • Bachelor's degree; Advanced degree or actuarial designation preferred
  • Major (only if required): Finance, Actuarial, Math, Healthcare or Business Administration, or related area
  • 10+ years of experience in Health Plan or Health Care System Finance and/or Network Management/Payer Relations experience with increasing levels of leadership
  • 10+ years of experience managing a staff and leading a team in implementation of complex financial projects that have a large financial and/or risk impact required
  • Extensive health care financial analysis experience directly related to provider reimbursement, with demonstrated expertise in contract modeling, reimbursement methodologies, value-based care, and risk-sharing strategies
  • Experience negotiating complex provider reimbursement contracts is strongly preferred
  • Experience with Government Programs reimbursement; Medicare/Medicaid required Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

Keywords: Medica Services Company LLC, Minnetonka , VP Provider Reimbursement & Analytics, Executive , Minnetonka, Minnesota

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