Value Based Programs Specialist

2 weeks ago

Philadelphia, United States Community Behavioral Health. Full time

**Core Expectations**:
Community Behavioral Health (CBH) will hold each employee accountable for the following expectations which align with our mission, vision, and corporate code of conduct.
- Perform key responsibilities as detailed in this job description in a dependable, responsible, and positive manner, consistent with all state and federal guidelines.
- Serve as a role model by exemplifying professional behavior, language, skills, and attire in order to promptly and accurately serve the needs of stakeholders, members and their families.
- Assure adherence to CBH policies and procedures so that all work is of the highest quality and delivered in the most culturally competent and cost-effective manner.
- Promote and manage diversity and acceptance within CBH and with all members and stakeholders by honoring and respecting their individuality, dignity and rights.
- Offer suggestions and develop solutions to help promote effective and efficient work processes and innovative programs.
- Actively participate in required meetings and complete all mandatory trainings.
- Maintain high levels of advocacy and member confidentiality to ensure the success of CBH and our mission.
- Assist in assuring both internal and external program integrity by being alert to and reporting suspected instances of provider and employee fraud, waste, or abuse.

**Essential Functions**:

- Analyze and interpret health care business and/or clinical data
- Demonstrate understanding of standard clinical models and grouping of claims at the event level
- Perform reviews of data reports with the ability to identify non-compliance with VBP payment or clinical guidelines
- Synthesize utilization data and adherence to regulatory and contractual guidelines, and prepare written reports for proposed VBP, Alternative Payment Arrangements (APA), and special projects
- Contribute to the VBP unit’s published materials including Provider Toolkit and news blast articles
- Act as liaison with other CBH departments including Provider Operations, Medical Affairs, Compliance, Quality, Clinical Management, and other Finance units in the development, implementation, and monitoring of program standards and payment strategies
- Stay current with applicable CBH, State, and Federal policies and regulations and National Committee for Quality Assurance (NCQA) policies related to Value Based Purchasing
- Participate in VBP unit presentations including provider training activities
- Conduct internal trainings and act as a resource for staff from both CBH and the Department of Behavioral Health and Intellectual disAbility Services (DBHIDS)
- Represent the VBP unit at internal, provider, and stakeholder meetings as assigned
- Review, contribute to, and maintain databases (e. g. Smartsheet, payment calendars, logs, etc.)
- Complete at least two VBP related trainings per calendar year
- Other duties as assigned

**Position Requirements**:

- _**Education**: Master’s degree in social services field.

**License/Certification**: N/A

**Relevant Work Experience**: Minimum of 5 years of work experience in the human services or public health field. Prior experience with value based payment models and/or regulatory/healthcare compliance is preferred.

**Skills**:

- Proficient meeting facilitation skills
- Ability to work independently
- Strong verbal and written communication skills
- Solid negotiation skills
- Ability to summarize findings and prepare reports in a concise manner
- Ability to understand and analyze clinical charts
- Proficiency in Microsoft Office

**Core Competencies**:

- ** Teamwork and Collaboration**: Build and sustain relationships with co-workers and stakeholders and support efforts and deliverables. Encourage unity and help remove barriers to productivity and success.
- **
Respect**: Treat each other and our members and stakeholders with respect and sensitivity, recognizing the importance of diversity.
- **
Member Centric**: Focus on the needs of our members by providing value-added services, promoting strong relationships and going beyond basic expectations to achieve the best possible outcomes.
- **
Honesty and Integrity**: Be open and honest in all we do. Maintain the highest level of integrity at all times.
- **
Commitment to Service Excellence**: Challenge ourselves to be forward-thinking and committed to providing total member and stakeholder satisfaction, first-in-class service and high quality, innovative programs.
- **
Compassion and Empathy**:Demonstrate a deep appreciation for another’s situation and point of view. Pay attention to emotional cues, listen effectively and show an exceptional level of caring about each person’s perspectives and circumstances.
- **
Problem Solving**: Build and implement logical solutions to resolving challenges/issues by using individual knowledge and experience while taking resources, constraints and CBH values into consideration.
- **
Initiative and Self-Directed**: Proactively manage time and res

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