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Central California Alliance for Health
Central California Alliance for Health
501 – 1.000 Angajați
AsigurăriAsistență medicalăConsultanță
Central California Alliance for Health este un plan regional de sănătate nonprofit care deservește membrii Medi-Cal din comitatele Mariposa, Merced, Monterey, San Benito și Santa Cruz. Activitatea sa acoperă îngrijirea medicală primară și comportamentală, serviciile farmaceutice, gestionarea bolilor și a cazurilor complexe, cu accent pe sprijinirea membrilor în coordonarea îngrijirii și accesarea serviciilor. Alianța susține, de asemenea, servicii stomatologice și oftalmologice, planificare familială, transport, asistență lingvistică, educație pentru sănătate și telemedicină și colaborează cu parteneri comunitari prin granturi pentru a îmbunătăți accesul local la îngrijire. Recrutarea sa sprijină echipele care susțin aceste programe de sănătate și comunitare.
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Locurile de muncă ale companiei

Payer Analytics Consultant

Model reimbursement strategies and assess payment methods for Central California Alliance for Health, a regional Medi-Cal managed care plan. Analyze financial outcomes to support effective payer reimbursement.

USStatele Unite ale AmericiiCACalifornia
118.000 $ – 140.000 $ / an
HibridNormă întreagăNivel mediuSeniorLimbă Obligatorie: englezăConsultant
SQLTableau

Descriere

  • Develop and validate managed care payer models
  • Assess the feasibility of reimbursement methods through moderately complex analysis
  • Analyze financial outcomes to support effective payer reimbursement
  • Work with internal and external stakeholders to meet reimbursement objectives
  • Report to the Payment Strategy Director
  • Support the Payment Strategy department in aligning network payments with revenue, advancing payment methods, improving care quality, and reducing costs

Cerințe

  • Bachelor’s degree in Business Administration, Accounting, Finance, Healthcare, or a related field
  • At least three years of experience conducting financial analysis of healthcare reimbursement
  • A master’s degree may replace two years of the required experience
  • An equivalent combination of education and experience may qualify
  • Knowledge of Windows PC systems; Microsoft Word, Outlook, PowerPoint, Access, Visual Basic, and Excel, including pivot tables; and database systems
  • Knowledge of financial modeling and analysis methods
  • Knowledge of provider reimbursement methods, pricing, and fee schedules for hospital, physician, and ancillary providers
  • Knowledge of healthcare terminology and healthcare data types and structures
  • Knowledge of fee-for-service and value-based provider reimbursement, including risk-sharing models
  • Knowledge of data modeling, SQL, business analysis and data mining tools, and Tableau
  • Ability to gather, interpret, and assess data, identify patterns, develop solutions, and anticipate the effects of recommendations
  • Strong analytical, critical thinking, and research abilities
  • Ability to troubleshoot problems, identify alternatives, and make recommendations
  • Ability to turn data into clear information and develop solutions that improve processes
  • Ability to serve as a technical resource and explain relevant regulations, processes, and programs
  • Ability to interpret and apply rules, regulations, policies, procedures, and guides
  • Ability to collaborate with people at all organizational levels and support multiple stakeholders
  • Must be currently authorized to work in the United States on a full-time, ongoing basis without current or future employer sponsorship

Beneficii

  • Fully benefited position
  • Medical, dental, and vision plans
  • Paid time off
  • 12 paid holidays per year
  • 401(a) retirement plan
  • 457 deferred compensation plan
  • Health and wellness program
  • Onsite EV charging stations
  • Attendance at quarterly company-wide events or department meetings

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