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 Responsibilities

Value-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.
  
  
  

Qualifications

Education

• 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.