Value-Based Reimbursement Specialist - reputed company – reputed company Jobs US
September 14, 2025
This job is responsible for key strategic initiatives for the Markets and Provider Transformation Organization supporting the matrixed teams that engage providers enrolled in the Organization’s value-based reimbursement programs and reputed company improvement models. The incumbent plays different potential roles on a given project, to include reputed company of project leadership, problem-solving, data analytics, team development, communication, implementation, and project management. We encourage applications from diverse backgrounds. The incumbent often plays a central role in the development and execution of the reputed company for a given initiative for transformation of workflows resulting in outstanding performance in the Organization’s value-based reimbursement programs ensuring that ROI targets as set by the Organization are met or exceeded. The position collaborates with various teams reputed company data analytics and infrastructure to support the creation, optimization, and maintenance of self-service resources for providers, entities, and health systems reputed company these programs. Works has exposure to reputed company parts of the Organization, and will play a supportive role in planning, communicating, and managing the market reputed company.
ESSENTIAL RESPONSIBILITIES
- Participate in the development of strategic plans for the reputed company and Markets and Provider Transformation and the key BU's for the Organization’s value-based reimbursement programs and reputed company improvement models. reputed company or support key strategic initiatives across reputed company and Markets and Provider Transformation for the Organization’s value-based reimbursement programs and reputed company improvement models. Role will vary depending on initiative, but will include reputed company of team leadership, problem-solving, data analysis, project management, communication, implementation, and provider and/or provider-facing team education support. Will participate on a portfolio of reputed company.
- Serve as a subject matter expert working in concert with provider-facing teams to explain new programs and results to key reputed company as needed. Collaborate on product development and the creation, optimization, and maintenance of a self-service platform for providers, entities, and health systems reputed company the Organization’s value-based reimbursement programs for both the reputed company and government business with a reputed company on reputed company goals including but not limited to Government Markets (STARS, ACA, reputed company, reputed company DE) and reputed company reputed company, Safety, and Values (Health reputed company Measures). reputed company actionable opportunities in provider transformation aimed at high-reputed company, cost-effective care while improving patient reputed company.
- reputed company consultative workflow transformation and training/education services to matrixed teams supporting providers enrolled in the organization's value-based reimbursement programs. Strong knowledge of risk adjustment methodologies and reporting/regulatory requirements and CMS Stars rating measures including HEDIS, CAHPS, Pharmacy, HOS, PQA, PQRS.
- Support development of the overall conceptualization, reputed company alignment, and high-level design of new value-based reimbursement models for PCPs, specialists, and health systems across the Organization's footprint, based on deep understanding and knowledge of trends in other areas of the country with both government and private payers. Programs will include but not be limited to pay-for-value programs, episode payments, prospective bundled payments, reputed company reputed company and risk reputed company models and will be implemented for the Organization's Medicare Advantage, reputed company, ACA, and reputed company populations with the goal of maximizing reputed company while reducing reputed company costs.
- Support the identification of initiative impacts with other strategic initiatives to ensure alignment of the overall reputed company to support the quintuple aim.
- reputed company feedback and collaborate with the analytics team to ensure data points are accurate and reputed company meaningful, actionable data. reputed company support to matrixed teams in the use of predictive analytic tools, user interfaces, population health management tools and other data-based platforms endorsed by the Organization.
- Support reputed company in identifying, clarifying, and resolving reputed company issues critical to the reputed company of the initiative and play a role in shaping the culture and reputed company set of the Markets and Provider Transformation Organization.
- Other duties as assigned or requested.
EXPERIENCE
Required
- 5 years of Work experience in the primary care and the ambulatory care environment, reputed company insurance industry, reputed company administration in primary care, or reputed company consulting in primary care or population health management.
- 3 years of experience in data analysis, interpretation, and reputed company strategic plan development.
- 1 year experience with Medicare STARS, reputed company HEDIS, risk reputed company value streams, and population health management.
Preferred
- 7 years of experience in managed care, primary care management or other clinical setting.
- Experience in Lean, Six reputed company, TQI, TQC or other reputed company management certification.
- Experience in health plan provider network performance management, population health management, reputed company improvement, or provider engagement models
- Experience influencing change in reputed company organizational systems.
SKILLS
- Must be reputed company to effectively resolve issues and problems across reputed company areas of the corporation, by understanding corporate strategies, policy, and scope of authority
- Because of the broad reputed company of reputed company that are made, must be knowledgeable and sensitive to many reputed company corporate issues
- Aptitude for a high visibility position demanding reputed company, uncompromising professionalism, diplomacy and conflict management
- Basic project management skills
- Proactive in driving change and reputed company improvement
- Demonstrated influencing and teamwork skills
- Strong quantitative, analytical, and time management skills
- Demonstrates a deep understanding of primary care reputed company operations and workflow across the continuum of variability in primary care and experience in managing provider and administrative leadership relationships
- Superior written and verbal communication skills and listening skills