Executive Director, Payment Transformation (Work from home)

About the role

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Responsibilities

• VBC Strategy Development, Model Creation & Governance
• Direct team accountable for development and support of payment strategies and model design, and alternative payment model implementation across all Lines of Business including:
• Primary Care Payment Strategies and Payment Models;
• Specialty Care Strategies and Payment Models;
• Hospital Payment Transformation Strategies and Models;
• Payment Model Design and Governance
• Payment Integrity Solutions
• Develop and manage the provider contracting guidance, contracting language, provider targeting & contracting readiness
• Drive the impact of programs through medical economic analysis, program evaluation and contract performance and annual strategy update
• Oversee VBC analytics including provider reporting platforms and VBC provider performance reporting.
• VBC Administration (Data, Platforms, Operations) & Provider Reporting
• Develop the strategy that will determine how we advance and administer our VBC services and technologies utilizing accurate data and platforms that enable network strategies and provider performance by operating with accuracy, auditability, and scale.
• Oversee cross-functional VBC platform, data and technology implementations and compliance by directing teams through planning, contracting, system deployments, testing, regulatory filings, provider data loads, and adherence to BCBSA, regulatory, and policy requirements.
• Lead VBC contract operations and network relationships by overseeing contract configuration, VBC payment operations, provider connectivity through data delivery, and optimization of operating model to achieve efficiency and accurate payments.
• Provide strategic and operational leadership by directing cross‑functional teams and people leaders, managing service levels and reporting, advancing administrative/financial/clinical capabilities, and delivering on divisional objectives through collaboration and execution.
• Oversee business data analytics services for VBC DCL and Enterprise Attribution including platform & delivery, operations & development and consulting & training that will lead to providing robust network analytics, analysis and insights to identify and enhance initiatives to improve the competitiveness of our networks and products
• Manage end-to-end provider reporting across multiple platforms to ensure actionable and accurate provider information on quality, cost, utilization and contract performance
• Review and approve annual operating plans and budgets for departments, vendors and sites under management, driving to greater admin efficiency and scale.

Requirements

• Bachelor’s degree and 10 years managed care experience at the health plan level or hospital/health system level, including direct responsibility for strategic network and financial management operations OR Masters Degree and 8 years of experience in a combination of healthcare consulting and/or data insights and finance relating to healthcare information
• 7 years management experience
• Leadership skills to lead team and drive results by working across departments.
• Experience with complex managed care concepts in a matrix management environment.
• Experience developing solutions/systems to support network development activities and Value Based Care programs.
• Expertise and/or demonstrated experience with business intelligence tools; designing, reporting and delivering analytical solutions; data management and warehousing, and the strategic use of information.
• Experience with enterprise-wide project coordination, project management, facilitation, presentation, and leadership experience.
• Experience in implementing large, complex multi-functional business systems into operations
• Experience with project management involving multi-functional team members.
• Experience in interacting and influencing diverse interest groups including providers, regulators, other health plans, members and staff.
• Knowledge of State and Federal laws and regulations.
• Knowledge of network management trends and innovations

Qualifications

• Clear and concise verbal and written communication skills including interpersonal and presentation skills.
• Experience with the insurance environment including trends in philosophy, theory, and applications concerning all products and services.

Benefits

Exact compensation may vary based on skills, experience, and location

Pay

$161,500.00 - $299,700.00

Schedule

Full time