Provider Payment Strategy Manager (Defined Term) at Central California Alliance for Health

, California, United States -

Full Time

Start Date

Immediate

Expiry Date

03 Jun, 26

Salary

191000.0

Posted On

05 Mar, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Provider Reimbursement Methodologies, Value-Based Payment, Feasibility Evaluation, Management Oversight, Subject Matter Expert, Staff Supervision, Mentoring, Provider Contracting, Data Modeling, SQL, Data Visualization, CPT Coding, HCPCS Coding, ICD 9/10 Coding, Managed Care Concepts, Analytical Expertise

Industry

Hospitals and Health Care

Description

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration. That’s why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer — and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. We have an opportunity to join the Alliance as the Provider Payment Strategy Manager in the Payment Strategy Department. This is a Defined Term position, which is designated by the Alliance and is a position of limited duration. Defined Term employees are usually hired to work in a specific department on specific long-term project work until the work is completed or to a specific end date not to exceed December 31, 2026. This is a Defined Term and fully benefited position. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Provider Payment Strategy Director, this position: Manages the advancement of provider reimbursement methodologies to align with organizational strategies and objectives, including value-based payment, and advises executive leadership regarding the feasibility of various strategies and methodologies Utilizes a variety of methods and models to evaluate the feasibility of reimbursement methodologies Provides management oversight and guidance related to the provider reimbursement function, acts as a subject matter expert, and provides guidance on departmental operations Manages, supervises, mentors and trains assigned staff ABOUT THE TEAM The Payment Strategy department ensures the Alliance's payments to our network are adequate to our revenue. We also work to advance our payment methodology in order to achieve the best quality healthcare while reducing costs. THE IDEAL CANDIDATE An experienced analytical and collaborative leader, with direct experience in managing provider payment strategies within a managed care setting Technically strong, with skill in provider reimbursement modeling, payment structure design and reimbursement strategies Strength in leading and mentoring teams while fostering ownership and accountability A collaborative and professional communication style, building productive relationships with internal teams and provider communities WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here. Knowledge of: Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers Provider contracting, including language, reimbursement methods, and rates Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical and provider data Data modeling techniques and business analytical and data mining tools, including SQL, and data visualization tools Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), ICD 9/10 and CPT codes, and industry standard groupers, such as ETGs, DRGs, and DCGs Managed care concepts, contracting, policies, and procedures Ability to: Develop work plans and workflows and organize and prioritize provider reimbursement activities Train, mentor, supervise, and evaluate the work of staff, promote an atmosphere of teamwork and cooperation, and motivate staff to achieve goals and objectives Apply analytical and pricing expertise to the evaluation, negotiation, implementation, and maintenance of managed care contracts Perform technical and non-technical troubleshooting and diagnose and resolve complex problems, including problems that may have multiple variables and may not have obvious solutions Develop data-driven and outcome-based initiatives to improve business decision making and improve business processes Education and Experience: Bachelor’s degree in Finance, Economics, Accounting, Health Care or a related field A minimum of eight years of experience performing provider reimbursement activities and/or provider payment strategy activities, including a minimum of three years of experience in a managed care environment, and a minimum of three years of management, supervisory, or lead experience; (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying OTHER INFORMATION We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. COMPENSATION INFORMATION The hiring ranges below represent a good‑faith estimate of what we expect to pay for this role upon hire and are not the full compensation ranges. Employees typically have opportunities for growth within the full compensation range over time based on performance and merit. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location). The applicable salary ranges are based on work location and are aligned to a zone according to the cost of labor in your area. All ranges are subject to change in the future. We are happy to provide the full compensation range for the role, answer any questions that you have, or share the applicable pay zone for your location if it’s not one of the typical areas included below. You can reach out to careers@thealliance.health, and a member from our Talent Acquisition team will be in touch. Typical areas in Zone 1: Santa Cruz, San Benito, and Monterey Counties, Bay Area, Sacramento, Los Angeles and San Diego areas Typical areas in Zone 2: Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento) Zone 1 (Monterey, San Benito and Santa Cruz) $168,000—$191,000 USD Zone 2 (Mariposa and Merced) $158,000—$180,000 USD OUR BENEFITS Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance. Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Responsibilities

This role manages the advancement of provider reimbursement methodologies to align with organizational strategies, including value-based payment, and advises executive leadership on strategy feasibility. The manager also provides oversight, acts as a subject matter expert for provider reimbursement, and supervises assigned staff.