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.