Payer Relations Manager

1 week ago

Southfield, Michigan, United States EPIC Health System LLC Full time
Job Title: Payer Relations/VBR/ACO Manager

Job Summary:

The Payer Relations/VBR/ACO Manager is responsible for developing and implementing 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 to ensure compliance with healthcare regulations, enhance financial performance, and improve patient outcomes.

Key Responsibilities:

  • 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.
  • Oversee Accountable Care Organization (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.
  • 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.
  • 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:

  • Law degree with experience in healthcare law, contract law, or health law, and licensed to practice in the state of Michigan, required.
  • Master of Business Administration (MBA)

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.

Background checks required.

To learn more about us, please visit:

www.epichs.org and https://nuwellnetworks.com

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