Location: Gainesville,GA, USA
Job Category:
Administrative & Clerical
Work Shift/Schedule:
8 Hr Morning - Afternoon
Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.
About the Role:
Job Summary
Within the organizational construct of HP2 and legacy Health Partners, this position provides financial analysis and reconciliation, data management and data analysis, proforma development support, oversight of critical data exchange with payers, compliance matters, and overall leadership for a variety of projects and programs to include, but not limited to all value-based payment models and initiatives. This position shall not only be a liaison with all program-related administrative and clinical teams but shall be active in all aspects of value-based payment operations with all payors to include negotiations, dispute resolution and performance improvement activities with a wide variety of stakeholders. This person shall be a reliable professional with broad knowledge of accounting, financial and business principles as this position plays a pivotal role in driving financial strategy, optimizing value-based contracts, and leveraging data analytics to enhance decision-making within our organization.
Minimum Job Qualifications
* Licensure or other certifications:
* Educational Requirements: Bachelors degree in healthcare management, accounting or finance.
* Minimum Experience: Experience managing value-based arrangements with business and clinical leadership. Five to seven years professional experience in a value-based/ACO type business related role.
* Other:
Preferred Job Qualifications
* Preferred Licensure or other certifications:
* Preferred Educational Requirements: Masters degree
* Preferred Experience:
* Other:
Job Specific and Unique Knowledge, Skills and Abilities
* Talented in the ability to plan, prioritize, and problem solve with skill and accuracy.
* Exceptional written and verbal communication skills for work with senior hospital executives, physicians, provider office staff and vendors.
* Copes effectively with ambiguity, unplanned change, and shifting priorities.
* Ability to assess a situation and quickly identify the right set of priorities to address the situation at hand.
* Decisive, solution minded, with the capability to persevere in difficult situations. Shall possess an open, collaborative leadership style that promotes teamwork and partnership while achieving desired results. Demonstrated ability to lead professionals through influence and collaboration.
* Proficient in team building, conflict resolution, change leadership, systems thinking, group interaction, results orientation, and budget management. Demonstrated knowledge of the intricacies of health plan/hospital/HMO/medical office operations and practices.
* Excellent skills in complex analytic problem solving, project management, lean thinking, change management, and group process.
* Exemplifies the organization's customer service standards.
* Improves work processes.
* Meets all mandatory educational requirements.
* Complies with confidentiality rules, polices, and regulations in all aspects of the job.
* Demonstrates working knowledge of safety practices.
* Promotes teamwork.
* Meets NGHS attendance standards.
* Utilizes financial resources effectively.
* Responds positively to change regarding work.
* Demonstrates respect for co-workers.
Essential Tasks and Responsibilities
* Ability to apply advanced data analytics tools and techniques to assess financial data trends, track key performance indicators to generate actionable insights and financial models to support key decision-making for payer negotiation purposes and strategic planning purposes.
* Works cross-functionally with teammates, management team, and external departments on implementation of a variety of Health Partners projects and programs that support the strategic goals of the organization in transitioning to value-based payment models.
* Oversees the budgeting process, ensuring accuracy and alignment with strategic objectives. Conducts financial forecasting to assist in resource allocation.
* Collaborates with senior leadership to develop and execute strategies aligned with the Health Partners' goals and objectives. Provides insights into financial risks, potential growth areas, and performance improvement opportunities.
* Oversees the financial calculations and exchange of data for gain share payouts to include reconciliation and coordinates the receipt of complete data on providers' performance on quality measures.
* Responsible to manage the value-based funds flow from payors; ensures that correct and timely payments are made following contractual obligations to include reconciliation of deficiencies and omissions.
* Monitors timely receipt of value payment obligations to include CCF, P4Q and shared savings. Maintains an organized and current record of value-based earnings for leadership. Reports on-going unresolved issues to the Executive Director.
* Establishes and implements training material regarding office technology.
* Works as HP2's dyad with NGHS IT department to ensure payor claims and eligibility files are ingested into payor platform and dashboards are developed.
* Works with external data vendors to support data analytic needs; requests and monitors receipt of special data analysis requests from external sources and performs data analysis and prepares reports and presentations as requested.
* Manages the planning, development, and implementation of program goals and objectives. Recommends changes to a project that is ongoing if it appears it is not proceeding on schedule or is producing unsatisfactory results. Develops an alternative course of action for completing a job should the initial plan fail to produce intended results.
* Develops project work plans to focus efforts and manage the day-to-day operational aspects of project goals.
* Performs data analysis and develops data drive opportunities for improvement, to align resources, and to ensure progress. Prepares presentations and presents findings to committees and leadership.
* Analyzes MLR contract performance, identifies trends and key opportunities for influence for executive leadership.
* Manages, models, and monitors the status of key strategic deliverables, operational milestones, and return on investment of programs. Ensures accurate and timely effort reporting for project personnel.
* Manages, reconciles, and resolves value-based payment disputes with payers. Supplies detailed reconciliation to provider groups for funding distribution purposes.
* Ensures compliance with federal regulations, reporting requirements, and internal policies. Organizes compliance obligations to include the annual CIN and MA related compliance education. Monitors changes to the compliance requirements from CMS and recommends program changes to leadership.
* Serves as the direct administration liaison between the HP2 leadership team, the physicians, physician groups' management teams, and external departments and vendors.
* Leads, coordinates, and monitors committee personnel and work group meetings as assigned.
* Prepares and presents financial reports, including proformas, to executive leadership, providing clear and concise insights on financial performance, variances, and recommendations to inform payor negotiations.
* Manages, coordinates, promotes, and audits educational opportunities of physicians and others that strengthen value-based payment knowledge from a compliance and regulatory position.
* Participates in the development of a structure that integrates collaborator physicians into decision making and strategic planning that support successful value-based payment arrangements. Facilitates and executes collaborator agreements as needed for value-based programs.
* Actively engages with key physician stakeholders to ensure they understand the value and opportunities HP2 represents.
Physical Demands
* Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time
* Weight Carried: Up to 20 lbs, Occasionally 0-30% of time
* Vision: Heavy, Frequently 31-65% of time
* Kneeling/Stooping/Bending: Occasionally 0-30%
* Standing/Walking: Occasionally 0-30%
* Pushing/Pulling: Occasionally 0-30%
* Intensity of Work: Frequently 31-65%
* Job Requires: Reading, Writing, Reasoning, Talking
Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.
NGHS: Opportunities start here.
Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.