Reimbursement Manager

The Value-Based Reimbursement/Payer Relations/ACO Manager is responsible for managing and optimizing value-based reimbursement strategies, fostering payer relations, negotiating payer contracts, and overseeing Accountable Care Organization (ACO) initiatives. This role involves collaborating with internal and external stakeholders within a matrix organization to ensure compliance with healthcare regulations, enhance financial performance, and improve patient outcomes.

Key Responsibilities

Value-Based Reimbursement

- Develop and implement strategies to maximize value-based reimbursement opportunities.

- Analyze financial and operational data to identify trends and opportunities for improvement.

- Collaborate with clinical and financial teams to ensure alignment with value-based care objectives.

Payer Relations and Contract Negotiations

- Establish and maintain strong relationships with insurance payers and other healthcare partners.

- Negotiate contracts and agreements with payers to ensure favorable terms and compliance with regulatory requirements.

- Serve as the primary point of contact for payer-related issues and resolution.

- Strategize and execute payer contract negotiations to optimize financial performance and reimbursement.

Accountable Care Organization (ACO) Management

- Oversee ACO initiatives, including performance monitoring, reporting, and compliance.

- Develop and implement strategies to improve quality of care, patient satisfaction, and financial performance within the ACO.

- Coordinate with clinical and administrative staff to ensure effective implementation of ACO programs and initiatives.

Regulatory Compliance

- Ensure compliance with all federal, state, and local regulations related to value-based reimbursement and ACO operations.

- Stay current with changes in healthcare regulations and payer requirements.

- Develop and implement policies and procedures to maintain regulatory compliance.

Data Analysis and Reporting

- Conduct detailed analyses of reimbursement trends and financial performance.

- Prepare and present reports to senior management, highlighting key insights and recommendations.

- Utilize data to drive decision-making and strategic planning.

Qualifications

Education

- Bachelors degree in healthcare administration, business administration, finance, health law, contract law, or a related field. Masters degree preferred.

Experience

- Minimum of 5 years of experience in healthcare administration, payer relations, value-based reimbursement, or ACO management.

- Proven track record of successful negotiation and relationship management with insurance payers.

- Experience with data analysis and financial reporting in a healthcare setting.

- Experience working within a matrix organization, effectively collaborating across multiple departments and teams.

Skills and Competencies

- Strong understanding of value-based reimbursement models and ACO operations.

- Excellent negotiation and communication skills.

- Proficiency in data analysis and financial modeling.

- Ability to manage multiple projects and priorities in a fast-paced environment.

- Strong problem-solving and critical-thinking abilities.

- Knowledge of healthcare regulations and compliance requirements.