Position Summary: Responsible for the analysis of Value Based reimbursement contracts and programs to optimize organizational performance. Utilizes technology and analytical tools to project performance on various value‐based plans. Provides financial projections based on performance and leverages data to identify areas of opportunity. Tracks, reconciles, and quantifies financial earnings from plan performance/earnings. Collaborates with internal and external partners. Dedicated role to centralize and coordinate the activities of contracted value‐based plans and GMG value‐based purchasing regulatory requirements such as the Merit‐based Incentive Payment System (MIPS) as well as various other value‐based contracts.
Education, License & Cert: Bachelor’s Degree in data analytics, healthcare, finance, or related field.
Experience: Extensive experience with Microsoft office or related database, spreadsheet, and presentation software required. Ability to analyze and leverage detailed information to direct initiatives for performance improvement. Experience with value‐based purchasing and/or reimbursement program implementation experience is preferred. Experience with quality chart reviews, abstracting, and/or coding preferred. Must organize, prioritize, and manage time efficiently to meet reporting deadlines. Proficiency in Excel and other software is required to perform job duties, such as preparing reports and developing spreadsheets. Must maintain effective interpersonal relations and communication skills.
Essential Functions: 1. Provides analytical support for value‐based programs, including independently monitoring/measuring the performance of the initiatives by leveraging data from multiple internal and external sources. Will perform analysis, summarize results, and oversee value‐based payments while adhering to established standards and processes. 2. Works as the subject matter expert for value‐based initiatives. Participates in projects to ensure the directives are executed and time sensitive deadlines met. Performs interpretation of legislative regulatory requirements frequently. 3. Identify areas of opportunity within Value Based Purchasing Contracts and participate, coordinate, and/or lead initiatives as appropriate for improvement. 4. Collaborates with VBR team to ensure prioritization of the organization’s reporting requirements. 5. With collaboration with contracting team, will analyze Value Based Purchasing portion of proposed contracts and provide both performance and financial projections based on contractual obligations and historical data. 6. Ability to project performance and identify areas of opportunity based on internal and external data, and project financial impact to organization in relation to achieved or underachieved goals. Will work collaboratively with clinical, financial, and operational leadership frequently. Must be able to communicate efficiently and identify barriers to involved stakeholders. 7. Creates diagrams and tracking mechanisms on a regular basis for communication of plan performance and staff productivity monitoring. Preparation of reports summarizing activities and performance metrics related to process improvement initiatives. 8. Tracks and Reconciles value‐based payments in accordance with plan performance/earnings. 9. Acts as a point of contact and facilitates implementation/integration for all contracted value‐based programs and GMG regulatory programs. Establishes and develops standard reporting procedures, to include collaboration with information technology team to advance digital reporting as needed. 10. Establishes and develops standard reporting procedures, to include collaboration with information technology team to advance digital reporting as needed. 11. Develops clinical quality measure reporting validation process and preforms thorough validation to ensuring accuracy of reports as well as ensuring fulfillment of regulatory and contractual standards. 12. Maintain accurate records; interpret rules and regulations, read, and understand patient records to correlate appropriate quality reporting measures. 13. Educates and performs strategic planning for quality reporting program efforts as directed. 14. Participates in professional development activities and maintains professional affiliations. Maintains confidentiality.
Other Duties: Performs other duties as assigned.