Location: Southfield,MI, USA
About the job 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 ResponsibilitiesValue-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. QualificationsEducation - 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.