Clinical Director Budgeting and Pricing - Remote

Paradigm • Walnut Creek, CA

122d • Remote

About The Position

We are seeking a full-time, remote Director of Budgeting and Pricing. This position is responsible for pricing accuracy and management of risk-based contract budgets and subsequent forecasts. This will be accomplished by working in collaboration with multiple teams including Clinical Operations, Provider Contracting, Bill Review, Analytics, and senior management.

Requirements

• Advanced degree in a healthcare related field.
• 10 years of experience in health care management emphasizing product deliverable management, business process leadership and success with multiple level client engagement.
• Strong working knowledge of workers compensation systems.
• Prior experience as Medicare Set-Aside Analyst or Life Care Planner including medical record analysis and summarization, cost projections, regulatory research and report preparation desired.
• Must maintain current understanding of state regulations and their impact on medical care and reimbursement in the workers compensation care market.
• Excellent oral and written communication skills; able to present to audiences of varying levels of expertise, difference in configuration including size, level of expertise and clinical and educational backgrounds.
• Leadership experience in a cross-functional environment where strong influencing, negotiating, motivating skills, and relationship building have been demonstrated.
• Successful track record with project management.
• Strong public speaking and presentation skills.
• Strong verbal, written and interpersonal communication skills.
• Strong organizational, problem solving, and analytic skills with good judgment with the ability to make timely and sound decisions.
• Ability to multi-task and manage multiple projects at one time.
• Customer focus, results orientation and strong business acumen.
• Ability to work well in a dynamic, high-paced team environment.
• Energetic, creative, flexible, organized, detailed oriented and self-motivated.
• Proficient in Microsoft applications including Word, Excel, PowerPoint, Visio.

Responsibilities

• Manage the analysis of submitted contracts, ensuring technical and clinical accuracy.
• Collaborates with Directors of Clinical Solutions for contract detail clarifications.
• Tracks custom requirements for pricing application.
• Presents final recommendations to proper levels of management authority for final price approval.
• Completes and distributes the Contract Value Analysis (CVA) for all applicable contracts within the designated timeframes.
• Completes and distributes the custom invoices for all applicable contracts within the designated timeframes.
• Direct oversight and management of the Clinical Budget Specialist Team responsible for financial liability for all provider services and other Contract-related costs.
• Partner with Director Clinical Solutions to manage the development of all new Contract budgets, including participation in clinical conferences.
• Research and document patient driven costs and provider rates that drive budget development and management.
• Utilize web driven and other electronic resources to identify potential costs, including use of CPT codes in the company’s electronic claims adjudication system.
• Complete all Rate Estimation requests to include accurate documentation of known or estimated financial liability in the system.
• Develop relationships with providers, including preferred provider organizations (PPOs), hospitals and specialty providers, ancillary services providers, and physicians.
• Maintain current knowledge of regulatory, industry and contractual factors to ensure the accurate estimation of Paradigm’s liability on each Contract.
• Collaborate with other internal departments (Contracting, Bill Review, Accounting) to address and resolve specific patient/provider issues.
• Collaborate with the clinical team including the Director of Clinical Solutions to determine the current and future medical/financial course and its impact to the financial forecast.
• Complete detailed review of clinical progress reports for key significant financial events and/or clinical confinements as well as a comprehensive review of paid claims.
• Update each forecast with findings/changes to include; update and confirmation of known/future service dates and expense using reference data and/or direct contract with the providers, true-up of forecast for completed services to paid claims, adjustment for future services based on changes in the clinical course of treatment.
• Work with the contracting department to request negotiations on interim services, and escalate issues related to outstanding confinement bills variations in paid claims estimates.
• Work with the Risk Analytics Team to determine trends and identify improvements that can be made to enhance the accuracy and ease of budget development and/or forecasting.
• Participate in high-level planning and decision-making with leadership.
• Handle recruitment and performance evaluations.
• Lead, mentor, and develop staff.
• Participate as required in Paradigm internal staff development programs.
• Other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Industry: Professional, Scientific, and Technical Services
• Education Level: Master's degree