at Highmark Health in Springfield, Illinois, United States
Job Description
Company :
Highmark Health
Job Description :
JOB SUMMARY
The incumbent works closely with internal customers responsible for enterprise value based reimbursement programs’ strategy, design, and operations. The incumbent understands key provider reimbursement concepts and has the ability to communicate and present those concepts effectively. Delivers high-quality analytics and insights to key decision-makers to help guide and design programs and initiatives. Performs innovative data modeling and routinely partners with data management staff in order to work efficiently and capitalize on data automation opportunities. Reports on value based reimbursement program outcomes, trends, and drivers to improve financial performance.
ESSENTIAL RESPONSIBILITIES
+ Develops internal and external facing provider reports/analytic tools to highlight key performance indicators for value based reimbursement programs and clearly define the significant trend drivers of overall financial/quality performance.
+ Designs scorecards and dashboards using advanced analytic tools to support value based reimbursement arrangements with large strategic partners in the market. Understands how the reports are used by strategic partners.
+ Supports the creation of value based reimbursement programs across the enterprise including initiatives for PCPs, specialists, facilities, post-acute providers, and ancillary providers. Understands how design of these programs creates financial value for the enterprise.
+ Interprets raw claims, provider, quality, and member data to build data sets for analytic and reporting purposes. Executes transparent and repeatable processes to access data.
+ Assists with provider cost savings analyses related to value based reimbursement and understands how return on investment impacts the enterprise and the provider. Helps generate ideas for potential cost-saving initiatives.
+ Reports on financial outcomes of value based provider arrangements and provider incentives to accurately reflect financial position. Assesses potential risks and opportunities and clearly defines scenarios for achieving certain outcomes.
+ Enhances department influence by providing responsive service and understanding customer needs. Effectively explains technical concepts to both technical and non-technical people.
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? EXPERIENCE
Required
+ 3 years of Relevant analytic work experience
Preferred
+ 3 years of Insurance or healthcare work experience
? SKILLS
+ Analytic Judgement
+ Effective Use of Technology
+ Efficient and Organized Work Habits
+ Strong Work Ethic & Standards
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EDUCATION
Required
+ Bachelors degree in Mathematics, Statistics, Finance & Accounting, Actuarial Science, Economics or related field or 6 years of relevant work experience in lieu of a Bachelor’s Degree
Preferred
+ Masters degree in Mathematics, Statistics, Finance & Accounting, Actuarial Science, Economics or related field
LICENSES or CERTIFICATIONS
Required
+ None
Preferred
+ None
Language (Other than English):
None
Travel Requirement:
0% – 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office- or Remote-based
Teaches / trains others
Occasionally
Travel from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
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:
$57,700.00
Pay Range Maximum:
$106,700.00
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 their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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Req ID: J237227
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