A Brief Overview:
Reporting to the Director, Operations, directs the administration and management of the administrative arrangement with the Third Party Administrator, including but not limited to, Claim, eligibility and capitation management in conjunction with TPA, Payor Relationships on overall analytic functions, and support contracting in ensuring contracts are updated and translated to TPA for proper reimbursements and all financial reporting. Serves in a management role in financial, clinical and operational planning and analysis related to value based care (VBC) payer arrangements. Works with senior management, clinical leadership, and external stakeholders to evaluate and model innovative VBC payment models such as quality/pay for performance, shared savings/shared risk, bundled pricing and capitation for specific populations. Technical services may include: data modeling, ETL design and development, master data management, data quality and governance.

What you will do:

• Performs administrative functions in support of the effective operation of the office. Works with NCH's contracted Third Party Administrator (TPA) vendor, Payors, staff, network physicians and other NCH personnel to ensure that optimal results in claims management, risk management agreements, administrative, and Network results are achieved. Regularly reviews Operational performance metrics/data, identifying opportunities to enhance performance.
• Assists with the administration of the capitated risk and Fee for Service contracts, including those operations that are provided by the contracted TPA vendor, to ensure that the contractual obligations of all parties are fulfilled and those contracts are effectively implemented.
• Collaborates on VBC analytic projects, including but not limited to: (1) facilitating the group process with senior management. (2) Perform sophisticated analysis including developing financial, clinical and operational models, evaluating environmental trends, core capabilities, competitive profile, and gap analyses. (3) Create complex reporting suites that provide insight for the purpose of action and improvement.
• Develops policies, procedures, manuals and other materials as needed to support the general administration, specific to data collection/analytics, as well as specific Payor Compliance Programs and all documentation files.
• Builds and continuously monitors reports/dashboards to track key healthcare quality and efficiency metrics by physician by payer.
• Regularly interacts with Payor representatives to address and resolve administrative and other relevant issues and ensures all administrative requirements are met based on Risk Products.
• Adheres to all Northwest Community Hospital standards, policies, and procedures.
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What you will need:

• Bachelors Degree Business Administration/Management Required Or
• Bachelors Degree Health Administration Required
• 5+ Years of progressively responsible provider-based managed care and/or physician group practice management experience. And
• 1 Year experience with EPIC, professional coder, knowledge of Tableau/Optum Analytics/etc.
• Interpersonal skills to interact effectively with physicians, all levels of NCH personnel, and external contacts.
• A high level of organizational and project management skills to manage multiple projects and daily operations simultaneously.
• Planning, critical thinking and analytical skills necessary to understand the relevance and impact of data; to evaluate program effectiveness and ensure accomplishment of financial objections, and to plan, develop and implement performance improvement initiatives.
• Advanced computer skills necessary to create and manage documents, reports, and presentations in Microsoft Word, Excel, PowerPoint and Access.
• Results-oriented, proactive, and self-directed with the ability to prioritize appropriately.
• Knowledge of hospital and physician (multi-specialty group, IPA or PHO) operations and services impacted by managed care.
• Knowledge of managed care models, financial reimbursement methodologies, clinical care management processes and utilization management concepts.

Benefits:

• Career Pathways to Promote Professional Growth and Development
• Various Medical, Dental, and Vision options, including Domestic Partner Coverage
• Tuition Reimbursement
• Free Parking at designated locations
• Wellness Program Savings Plan
• Health Savings Account Options
• Retirement Options with Company Match
• Paid Time Off and Holiday Pay
• Community Involvement Opportunities