Value Based Pay Manager

Full Time
Medford, OR 97504
Posted
Job description
Value Based Pay Manager
Full Time | Salary


We’re committed to compassionate care for all. Our patients. Our employees. You.

At La Clinica, we love our patients and enthusiastically treat them with the same care, respect, and dignity that we would our friends, family, and neighbors because that's who they are. If this appeals to you, La Clinica might be the right place to build your career. We’re looking for the right team members to treat our patients with this level of care.

We extend our commitment to compassionate care to our employees as well. We invest in our employees' lives through competitive pay, comprehensive benefits packages, easy access to wellness, personal and professional development workshops, and a focus on healthy work-life harmony. Check out our careers page to learn more about why our employees love working at La Clinica.

The Value Based Pay Manager is responsible for leading and administering the capture, management, collection, and optimization of alternative payment revenue across all service lines. This position reports directly to the Chief Financial Officer and will take a hands-on approach in contributing significantly to the concept, design, and implementation of the organization’s reimbursement functions to secure and enhance revenue opportunities.

The role requires advanced knowledge and experience with various revenue cycle processes to include, but not limited to, patient services revenue (medical, behavioral health, dental and pharmacy) as it relates to various payors including Medicaid, Medicare, and third-party commercial insurers; value-based contracts and payment systems; and grant budgets and reporting.

The right candidate understands, models, articulates, anticipates, and influences the value of alternative payment opportunities and the way they improve overall health of the populations we serve.

Accountabilities Include
:
Performs Essential Job Duties
  • Works with the CFO and Data Analytics Director to identify non-duplicative areas of financial analysis. .
  • Develop and maintain analytical models, reports and dashboards that guide insightful decision-making as it relates to value-based care strategies.
  • Works with senior leaders to identify opportunities for all value-based pay contracts and alternative payment arrangements with payers.
    • Coordinates financial reporting and accountability measures for the Alternative Payment Care Model (APCM) program in alignment with the Population Health department.
    • Identifies revenue opportunities in the Medicare program and positions the organization to take advantage of new ACO programs or payment initiatives.
    • Anticipates trends and future changes in payment methodologies and prepares the organization to take advantage of strategic opportunities.
    • Prepares financial reports that identify opportunity gaps in Patient Centered Primary Care Home payments (PCPCH) and HRSA quality measures, and coordinates with leaders to ensure financial improvement targets are met.
  • Provides support to the Revenue Cycle Manager in efforts to identify and implement new billable revenue opportunities.
  • Works with PrimeCare as La Clinica’s Independent Provider Association (IPA) responsible for fee-for-service contracts with all insurance payers
    • Identifies opportunities to maximize revenue and value-based contracts with commercial insurers and works with leaders to ensure alignment with other value-based pay activities. Collaborates with leaders across the organization to model and make visible information that is in alignment with payment contracts.
  • Ensures leaders receive timely and actionable financial reports to close gaps in revenue improvement efforts.
  • Provides leadership and organizational support to the Primary Care Strategy Committee, attending to the alignment between quality metrics, financial and value-based pay contracts, and operational alignment strategies that improve the overall goals of improved health, decreased healthcare cost, improved satisfaction of patients and caregivers in primary care.
  • Works with the Contracts team to administers Medicaid, Medicare, and third-party payor contracts, ensuring timely renewal and alerting the organization to upcoming changes, and researching, analyzing, and reporting the financial and potential workflow impacts to senior management.
  • Collaborates with the revenue cycle manager, as well as other internal partners, to explore new and/or changing revenue opportunities and develops strategies through internal/external workflows as well as researching and ensuring requirements are met.
  • Completes all finance-related federal, state, and other regulatory reporting as required including, but not limited to, Uniform Data System (UDS) reporting.
  • Identify opportunities, produce exceptional processes and technical documentation in the development of a robust financial framework to support strategic initiatives of the organization.
  • Follows established departmental policies, procedures, and objectives, continuous quality improvement objectives, and safety and environmental standards.
  • Completes assigned trainings via La Clinica’s learning module system (Relias) by required due date.
  • Other duties as assigned.

Customer Service
:
Develops and maintains professional, support-oriented working relationships with patients, employees, team members, and community partners. Demonstrates continuous improvement in achieving “developing” and “fully competent” levels of La Clinica’s Behavioral Standards.

Follow La Clinica’s SERVE standards and they are the following:
  • Service: I provide, helpful service focused on the needs of others.
  • Empathy: I welcome and connect with you on a personal level.
  • Relationships: I create partnerships, working a way that benefits everyone.
  • Value: I recognize the importance of others and treat everyone with respect.
  • Excellence: I go above and beyond to deliver an exceptional experience.

Qualifications
:
Must be able to interact with a variety of individuals at various levels under stressful circumstances while exercising sound judgement, tact, and diplomacy; work productively both independently and in a team setting; communicate with clarity, both verbally and in writing to groups and individuals.

Must have the following acquired knowledge:
  • Knowledge of auditing concepts and principles.
  • Ability to analyze complex payment arrangements and their links to specific clinical services.
  • Ability to maintain quality and safety standards.
  • Knowledge of current and developing issues and trends in value-based payment arrangements.
  • Advanced knowledge of grants management, budget development and regulatory issues with federal partners.
  • Analytical and problem-solving skills.
  • Ability to gather data, compile information, and prepare reports.
  • Ability to use independent judgment and to manage confidential information.

Education and/or Experience
:
Required:
  • Bachelor’s degree in finance/accounting, healthcare administration or related field and three years’ experience in revenue cycle optimization, or a minimum of seven years’ experience in a revenue cycle management
  • Subject matter reimbursement expert in the areas of Medicaid, Medicare, and other third-party payor contracts
  • Excellent understanding of federal, state, and local compliance standards and HIPAA regulations
  • Solid critical thinking and problem-solving skills
  • Excellent interpersonal communication, and problem-solving and leadership skills
  • Track record of success in fast-paced, high-accountability environments.
  • Self-motivated, self-starting personality
  • Ability to work independently and manage multiple projects with competing priorities.
  • Proficient in Microsoft Office applications, particularly skilled in Excel

Language Skills
:
Must have the ability to communicate with clarity, both verbally and in writing; read, analyze, and interpret complex documents, regulations, policies, and procedure manuals; and create professional business documents. Preferred English/Spanish.

Mathematical Skills
:

Must have the ability to add; subtract; multiply; use percentages, fractions, decimals; interpret numeric graphs; and apply basic algebra, geometry, and statistics.


Reasoning Ability
:
Must have the ability to:
  • Understand confidential document security from a legal perspective.
  • Effectively deal with a variety of abstract and concrete variables.

Other
:
  • Must have accessible phone service, working on a computer and/or laptop, and reliable transportation.


Equity Statement:

At La Clinica, we commit to engage everyone in a welcoming, respectful, and loving way and to maintain the dignity and value of all people above everything else. These standards align with our organization’s vision of absolute excellence, open-hearted community, and well-being for all.


For more information, please visit our website at: https://laclinicahealth.org/patients/approach/


A
pplications will be reviewed by the appropriate Department for interview; those selected must be able to provide proof of legal right to work in this country. Criminal history background check and pre-employment drug screen will be performed prior to any job offers. La Clinica is a drug free work environment. Equal Opportunity Employer. La Clinica complies with the Americans with Disabilities Act. If you consider yourself disabled and desire assistance in the application process, please contact the Human Resources Department.

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