Senior Director Provider Reimbursement and Measurement

BCBSM • Fort Lauderdale, FL

282d • $149,400 - $261,400

About The Position

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. As the Senior Director, you will oversee value-based payment design, budgeting, provider analytics, and provider reporting, internally and externally, within the Provider Network division. Responsibilities include strategic planning, modeling, evaluation, in support of the Provider Relations division in support of negotiation strategies, provider performance reporting and analysis and overall provider performance management and strategy. The position involves reporting and analytics to present provider performance data both internally and externally, developing and monitoring the provider payment strategy in relation to value-based contracts, settlement functions, and new incentive programs. The Director is tasked with leading and motivating the team, supporting pricing and performance aspects of provider reimbursement including both fee-for-service and value-based contract negotiations, spearheading the development work of value-based program execution, and collaborating with the Provider Partnership and enablement teams to ensure alignment.

Requirements

• 7+ years of related professional experience, with 5+ years of management experience.
• Demonstrated leadership skills and experience in managing goals through collaboration and teamwork.
• Business expertise, financial acumen and interpersonal skills to effectively work within a complex organization to influence change.
• Demonstrated success with problem-solving, complex contractual negotiations, as well as experience with effective analysis and data modeling.
• Strong creative thinking, problem solving and critical thinking skills.
• Excellent oral and written communication skills that can be effectively applied to making public presentations.
• Delegation, supervisory and mentoring skills.
• Strong financial background with a deep understanding of provider reimbursement methodologies for professional, facility and ancillary services including DRG and CPT based payment methodologies.
• Ability to work independently and to make sound business decisions.
• Broad knowledge of the health care industry, related regulatory requirements and financial risk arrangements with providers.

Nice To Haves

• Bachelor's degree.
• Masters degree in business, finance, mathematics, economics, healthcare administration or related field.
• Relevant leadership experience in a provider organization.

Responsibilities

• Establish, lead and manage analytical reporting to support strategic initiatives, value-based contracts and overall provider reporting and data strategies.
• Establish a strategy for defining advance reporting and analytics to help educate providers on their performance in delivering affordable, high-quality care using comparative analyses in partnership with Provider Partners.
• Collaborate with other internal stakeholders to help develop and implement contracting strategies, payment methodologies, and network configurations that meet Blue Cross's financial and non-financial objectives.
• Support the design, development, alignment, and implementation of provider negotiation and financial strategies.
• Represent Provider Relations on cross-divisional activities around data governance, advance analytics, trend meetings, and other committees as determined.
• Lead team in developing data and delivering financial models to support provider reimbursement.
• Act as the Representative for all Network Management finance and analytics on joint operating and governance committees with provider organizations or internal committees.
• Lead committees and workgroups related to provider data and reporting strategies and financial impact analyses.
• Collaborate with internal divisions including Commercial and Government markets, Actuarial, Corporate Finance and Accounting, Data and Analytics and others to integrate the provider financial strategy into corporate objectives and RFP's.
• Lead committees and workgroups that relate to provider financial strategy.
• Direct and amend policies and processes for audit requirements related to provider payment, negotiations, and fee schedule updates.
• Guide staff on professional development, strategic thinking, and stakeholder relationship management.

Benefits

• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree