Provider Payment Strategy Manager (Defined Term)

We have an opportunity to join the Alliance as the Provider Payment Strategy Manager in the Payment Strategy Department.

This is a Defined Term position, which is designated by the Alliance and is a position of limited duration. Defined Term employees are usually hired to work in a specific department on specific long-term project work until the work is completed or to a specific end date not to exceed December 31, 2026. This is a Defined Term and fully benefited position.

Reporting to the Provider Payment Strategy Director, this position:

• Manages the advancement of provider reimbursement methodologies to align with organizational strategies and objectives, including value-based payment, and advises executive leadership regarding the feasibility of various strategies and methodologies
• Utilizes a variety of methods and models to evaluate the feasibility of reimbursement methodologies
• Provides management oversight and guidance related to the provider reimbursement function, acts as a subject matter expert, and provides guidance on departmental operations
• Manages, supervises, mentors and trains assigned staff

The Payment Strategy department ensures the Alliance's payments to our network are adequate to our revenue. We also work to advance our payment methodology in order to achieve the best quality healthcare while reducing costs.

• An experienced analytical and collaborative leader, with direct experience in managing provider payment strategies within a managed care setting
• Technically strong, with skillin provider reimbursement modeling, payment structure design and reimbursement strategies
• Strength in leading and mentoring teams while fostering ownership and accountability
• A collaborative and professional communication style, building productive relationships with internal teams and provider communities

To read the full position description and list of requirements, click here.

• Knowledge of:
  
  
  
  • Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers
  • Provider contracting, including language, reimbursement methods, and rates
  • Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical and provider data
  • Data modeling techniques and business analytical and data mining tools, including SQL, and data visualization tools
  • Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), ICD 9/10 and CPT codes, and industry standard groupers, such as ETGs, DRGs, and DCGs
  • Managed care concepts, contracting, policies, and procedures
  
  
  
  
• Ability to:
  
  
  
  • Develop work plans and workflows and organize and prioritize provider reimbursement activities
  • Train, mentor, supervise, and evaluate the work of staff, promote an atmosphere of teamwork and cooperation, and motivate staff to achieve goals and objectives
  • Apply analytical and pricing expertise to the evaluation, negotiation, implementation, and maintenance of managed care contracts
  • Perform technical and non-technical troubleshooting and diagnose and resolve complex problems, including problems that may have multiple variables and may not have obvious solutions
  • Develop data-driven and outcome-based initiatives to improve business decision making and improve business processes
  
  
  
  
• Education and Experience:
  
  
  
  • Bachelor's degree in Finance, Economics, Accounting, Health Care or a related field
  • A minimum of eight years of experience performing provider reimbursement activities and/or provider payment strategy activities, including a minimum of three years of experience in a managed care environment, and a minimum of three years of management, supervisory, or lead experience; (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying
  
  
  
  

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

COMPENSATION INFORMATION

The hiring ranges below represent a goodfaith estimate of what we expect to pay for this role upon hire and are not the full compensation ranges. Employees typically have opportunities for growth within the full compensation range over time based on performance and merit. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location).

The applicable salary ranges are based on work location and are aligned to a zone according to the cost of labor in your area. All ranges are subject to change in the future. We are happy to provide the full compensation range for the role, answer any questions that you have, or share the applicable pay zone for your location if it's not one of the typical areas included below. You can reach out tocareers@thealliance.health, and a member from our Talent Acquisition team will be in touch.

Typical areas in Zone 1: Santa Cruz, San Benito, and Monterey Counties, Bay Area, Sacramento, Los Angeles and San Diego areas

Typical areas in Zone 2: Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento)