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The Healthcare Value Consultant II will participate in the development and coordination of innovative programs designed to transition from fee-for-service reimbursement to a system based on value by monitoring the performance of some of the largest and most complex health systems in the state of Louisiana under this new system. The Consultant is responsible for handling the following for their assigned Accountable Care Organization Plans, Medicare Advantage Rewards Programs, etc.: operationalize the Plan's total cost of care/ shared savings arrangements and/or quality arrangements and manage the relationship of reporting data for the alternative value based programs and risk arrangements.
The Consultant will provide technical and analytical support by independently researching, analyzing, developing, deploying, and monitoring/measuring the performance of provider partners by leveraging utilization, financial, clinical, and benchmark data from multiple internal and external sources. The incumbent will serve as the primary contact to help providers understand clinical and economic opportunities to achieve the quality and financial goals of the Shared Savings program, Blue Advantage Rewards Program, etc. ultimately leading to delivery model redesign.
Furthermore, staff responsible for supporting Affordable Care Organization may monitor the operational performance of unique risk sharing arrangements between the Plan and some of the largest health systems in the state of Louisiana. By doing so, the Consultant will enable the expansion of further such arrangements throughout the state.
The Consultant may guide and direct less experienced staff within the department on analyses and serve in more of a lead capacity as assigned by management.
**Necessary Contacts** :
In order to effectively fulfill this position the incumbent must be in contact with: Facility Reimbursement, Professional Reimbursement, Provider Audit, Medical Coding, Legal, Network Administration, Clinical Partnerships, Medical Directors, Care Management and Health Informatics staff as well as Physicians, Hospital administration executives, clinically integrated provider system personnel, other healthcare providers, and vendors.
A bachelor's degree in statistics, accounting, finance, math, information systems or related field is required. Four years of related healthcare, finance and/or statistical analysis may be used in lieu of degree. An MBA, MHA, CPA, or CFA is preferred.
Three years of experience in health care finance or in a related field is required. An MBA, MHA, CPA, CFA or related healthcare, financial or analytically based degree may substitute for one of the two total years of required experience. Healthcare financial analysis and reporting experience for a health plan is preferred.
Ability to work independently and cooperatively on teams, maintaining positive relations with providers.
Existing knowledge of key industry concepts such as narrow networks, shared savings arrangements, and risk sharing is required.
Requires utmost interpersonal skills to manage complex aspects of the dynamic value based programs and risk sharing arrangements between the Plan and some of the largest health system in the state of Louisiana.
Requires strong analytical skills with an ability to navigate multiple software systems and handle large volumes of data.
Excellent communication and report preparation skills with highest degree of accuracy are required. Must have the ability to effectively present information to both internal and external stakeholders.
Excellent problem-solving, decision making and project management skills are required.
Excellent attention to detail, research, and documentation skills are required. High proficiency in Microsoft Office Software (Excel, Word, PowerPoint, and Outlook) is required. Experience using SQL and Access is strongly preferred.
Experience prioritizing, organizing and coordinating multiple work assignments under strict internal and external deadlines often in a high pressure setting with minimal supervision.
Ability to travel 25% and work extended hours.
Additional Qualifications for staff supporting the Blue Advantage Rewards Program:
Must have experience in Medicare Advantage Program Concepts including HEDIS, Star Ratings and RAF.
**ACCOUNTABILITIES & ESSENTIAL FUNCTIONS** :
Responsible for Accountable Care Organization program implementation and/or Blue Advantage Rewards Program engagement, focusing on partnering and building relationships with providers to support care delivery transformation through analytics, reporting, and clinical process improvement while cognizant of the current reimbursement and quality improvement programs of the Plan.
Develop and communicate healthcare transformation insights for providers by leveraging utilization, financial, clinical, and benchmark data from multiple internal and external sources.
Provide technical and analytical support, develop methodologies, perform analysis, summarize results, and develop conclusions.
Analyze performance of some of the largest providers in the state under the ACO Program and/or Blue Advantage Rewards Program, recognizing that expansion efforts throughout the state will produce different market dynamics requiring complex research, analysis, reporting and relationship building expertise
Actively engage providers by analyzing, presenting and translating clinical quality and cost data in meaningful ways to identify actionable items that will improve operations, clinical outcomes, and overall population health.
Monitor and research health care and health industry developments on best practices and initiatives in developing new provider payment and network models to support more coordinated, efficient and quality-driven healthcare.
Demonstrate problem-solving, quantitative and analytical skills while validating data for reasonableness/accuracy and adapting to a wide variety of changing analytical situations.
Serve as an effective team player who manages relationships with designated provider partners.
Accountable for complying with all laws and regulations associated with duties and responsibilities.
Ability to travel 25% and work extended hours.
Job duties are performed in a normal and clean office environment with normal noise levels.
Work is predominately done while standing or sitting.
The ability to comprehend, document, calculate, visualize, and analyze are required.
**Additional Accountabilities and Essential Functions for staff supporting Accountable Care Organization Programs:**
Responsible for utilizing multiple analytical tools to monitor the operational performance of unique risk sharing arrangements between the Plan and some of the largest health systems in the state.
Identify trends in existing arrangements to guide the strategic direction of the Plan related to future expansion of risk sharing arrangements to different markets across the state.
Facilitate interactions between the Plan and some of the largest health systems in the state related to other strategic initiatives such as but not limited to data exchange, alternative reimbursement models, and provider expansion efforts.
**Additional Accountabilities and Essential Functions for staff dedicated to the Blue Advantage Rewards Program:**
Collaborate with other departments (Clinical, Risk Adjustment, Medicare Operations) on providing analysis and reporting for successful engagement and interaction for internal and external relationships
Actively partner with other departments (Clinical, Risk Adjustment, Medicare Operations) on providing detailed analysis, reporting, education and support to Providers in the Blue Advantage Rewards Program to promote financial success, membership growth, and star ratings
**An Equal Opportunity Employer**
**All BCBSLA EMPLOYEES please apply through Workday Careers.**
PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI) Associated topics: cbo, coding, collection, data entry, front, hospital transcriptionist, medical biller, medical transcriptionist, receivable, review
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.