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Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

This position shall contribute to the value-based contracting team responsible to support an enterprise wide portfolio of value-based programs that span government and commercial payers. This position shall collaborate with and engage executives and physician leadership in assessing and executing value-based strategy through a wide range of value-based contractual arrangements including pay for performance and various levels of risk.

Minimum Job Qualifications

• Licensure or other certifications:

• Educational Requirements: Bachelor's Degree in healthcare administration, finance, mathematics or other related discipline required.

• Minimum Experience: 7 or more years of successful experience organizing and negotiating value based payment terms with Medicare Advantage and Medicaid plans; Advanced knowledge of and ample experience in value-based care and risk based contracting with a broad range of providers; Proficient in excel and managing key contractual inputs that drive the proforma

• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications:

• Preferred Educational Requirements:

• Preferred Experience: Experience working in a CIN or ACO

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Strong communication and negotiation skills

• Demonstrates solid value-based contracting expertise in developing and negotiating value-based contractual terms with payers

• Detail oriented. Questions the unusual

• Highly organized with ability to multi-task and prioritize duties and responsibilities

• Ability to think independently and problem solve with both internal and external constituents

• Proficient in Microsoft Office applications (Work, Excel, Outlook, PowerPoint)

• Ability to develop strong, trusting relationships with co-workers, managers, directors, and payers

• Must be self-motivated, dependable, and maintain a high-level of confidentiality

Essential Tasks and Responsibilities

• Lead payer negotiations for Health Partners and HP2 in dyad with executive leadership

• Evaluate and make recommendations on new and changing value-based contracting proposals and opportunities working in concert with the analytics and quality teams including finance and contracting committee members

• Manage on-going obligations of executed contracts to ensure both HP2 and the payer are meeting performance expectations elevating critical and recurring issues to leadership

• Collaborate with payers and manage and/or lead the required Joint Operating Committee meetings and/or finance meetings as assigned. Ability to take the lead as well as contribute as a participant in committee meetings and work sessions

• Resolve complex contractual problems that require judgment and independent thinking

• Act with a fluent and comprehensive knowledge of value-based contract language and terms

• Apply a deep understanding of provider reimbursement methodologies for physicians, ancillaries, and hospitals in all transactions.

• Conduct analysis of complex financial models using assumptions and scenario planning

• Shall manage the inputs that support the proforma

• Draft, edit and prepare counter proposals to include complex contract documents and reimbursement attachments

• Draft content for presentations and agendas for HP2 committee meetings and payer meetings, maintain notes and/or minutes as deemed necessary

• Conduct research and analysis to support filing appeals with the payers working in partnership with other members of the HP2 team

• Compiles, maintains and reviews value-based contracts and risk contracts portfolio for the purpose of identifying opportunities to improve contract terms and structures

Physical Demands

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time

• Weight Carried: Up to 20 lbs, Occasionally 0-30% of time

• Vision: Heavy, Constantly 66-100% of time

• Kneeling/Stooping/Bending: Occasionally 0-30% of time

• Standing/Walking: Occasionally 0-30% of time

• Pushing/Pulling: Occasionally 0-30% of time

• Intensity of Work: Occasionally 0-30% of time

• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding,

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.