Resp & Qualifications
PURPOSE: CareFirst has corporate goals to transition from paying fee-for-service to value-based contracts. The primary function of this position is to plan, direct and control the following activities: provider finance in value-based contracts; develop and support measurement criteria in contracts; run reporting related to provider reimbursement and reconciliation; make arrangements for quarterly incentive payouts.
This position reports directly to the Vice President of Practice and Payment Transformation. The incumbent is responsible for the formulation of CareFirst policy and strategy with respect to provider and system financing to administer financial incentive payout and loss collection. The incumbent will be required to understand contracts, measurement criteria, run reports, deal with exclusions/exceptions, make arrangements for payouts that are auditable and ultimately routinized. This position will work closely with Provider Contracting Accounts Payable, and Actuarial departments.
Under the general supervision of the Vice President of Practice and Payment Transformation the incumbent’s accountabilities may include, but are not limited to, the following:
• Bachelors degree in business or finance.
• Must have a minimum of 5-7 years’ experience in the health care industry and at least 3 years of increasing responsibility in a management position.
• Proven ability to build and lead a team, providing coaching and development and ensuring alignment of skills and knowledge with business needs.
• Possess a thorough understanding of hospital and health care contracts and reimbursement methodologies, value based contracting methodologies and contract compliance, and fee-for service payment management.
• Possess a broad understanding of revenue cycle management and claims adjudication.
• Must demonstrate resilience and effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
• Previous managed care, State and/or Federal health care programs (i.e., Medicaid, Medicare) or health insurance payor industry experience.
• Healthcare operations experience
• Experience in administration of Medicare/Medicaid health plans
• Knowledge of Maryland’s regulated hospital rate setting system
• MBA or CPA
Value Based Contracting
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 09/13/2019
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship