Provider Payment Strategy Manager

Company: The Alliance
Location: Bakersfield
Posted on: May 8, 2025

Job Description:

We have an opportunity to join the Alliance as the Provider Payment Strategy Manager in the Payment Strategy Department.WHAT YOU'LL BE RESPONSIBLE FORReporting 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 staffABOUT THE TEAMThe 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 skillin 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 communitiesWHAT YOU'LL NEED TO BE SUCCESSFULTo read the full position description, and list of requirementsclick 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
    • 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
      • 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 qualifyingOTHER 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.The full compensation range for this position is listed by location below.
            
            The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego areaTypical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka areaZone 1 (Monterey, San Benito and Santa Cruz)$126,685 - $202,696 USDZone 2 (Mariposa and Merced)$115,283 - $184,454 USDOUR BENEFITSAvailable 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 StationsABOUT USWe 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 ourFact 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 employerAt 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.Deaf and Hard of Hearing Assistance Alliance
              TTY Line: 877-548-0857The Alliance Nurse Advice Line
              844-971-8907 (TTY) or dial 711
              24 hours a day, 7 days a week
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Keywords: The Alliance, Ventura , Provider Payment Strategy Manager, Executive , Bakersfield, California