Job Information
MEDICA HEALTH PLANS Director Provider Reimbursement in MADISON, Wisconsin
JOB REQUIREMENTS: Description The Director of Provider Reimbursement provides dedicated analytical support to the ongoing development of Medica\'s provider payment strategies and business plans, expansion of service lines, and assessment of market opportunities. Key Accountabilities Provider Payment Methodologies Develops and leads the implementation of new payment methodologies to ensure leading edge performance for all segments. Price Transparency Drives the collection, validation, analysis and effective use of provider transparency rules to effectively position Medica competitively in the market. Expansion Market Support Develops financial arrangements and opportunities for all providers in expansion markets ensuring competitive positioning for contract rates structures. Value Based Arrangements Provides strategic development to Network Management team and others in the creation of the next generation value based models. Drives research and analysis to determine the best approaches and methodologies for Medica in relation to new ACO development and implementation. Innovative Payment Designs Leads the research, analysis and implementation regarding innovative payment activities, such as COE, bundles to determine the best approaches for Medica. Contract Modeling Works to support contract modeling team and consistently evaluates and ensures an effective contract modeling process where needed upgrading the tools and processes in conjunction with the contract modeling team. Leadership Provides leadership, coaching, and skill development for the Reimbursement team. Ensures that staff has appropriate analytic tools to effectively accomplish assigned responsibilities. Qualifications Bachelor\'s degree or equivalent experience in related field. Major in Finance, Actuarial Science, Math, Economics, Statistics or related area of study 10 years of work experience beyond degree Minimum of 5 years of experience managing a staff and leading a team in complex actuarial projects that have a large financial and/or risk impact preferred Skills and Abilities Health plan financial, underwriting, and provider experience with increasing levels of leadership Value based arrangement experience including alternative payment arrangements Experience with Government reimbursement Demonstrated ability to manage diverse personalities and create a cohesive team environment Excellent analytical, problem-solving, and decision-making skills Strong leadership and team management abilities Strong verbal, written, and interpersonal communication skills, with the ability to adapt to different communication styles Ability to work effectively in a fast-paced, dynamic environment Proficient in Microsoft Suite, specifically Excel and PowerPoint This position is a Hub role, which requires an employee to occasionally come onsite to the designated office -... For full info follow application link. Equal Opportunity Employer including Veterans and Disabled Individuals ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/185742A6D92A441F