Value Based Programs Specialist

Philadelphia, PA, United States

Job Description Job Description

The Value Based Programs (VBP) Specialist will support the development, implementation, and monitoring of value based reimbursement programs. Using business intelligence applications, the Implementation Specialist will work as part of the VBP team to identify financial and clinical opportunities to enhance performance under VBP arrangements, and to analyze and report on development and implementation status, monitoring activities, and outcomes. The analyst will report directly to the Director of VBP.

Core Expectations:

Community Behavioral Health (CBH) will hold each employee accountable for the following expectations which align with our mission, vision, and corporate code of conduct.

Perform key responsibilities as detailed in this job description in a dependable, responsible, and positive manner, consistent with all state and federal guidelines.

Serve as a role model by exemplifying professional behavior, language, skills, and attire in order to promptly and accurately serve the needs of stakeholders, members and their families.

Assure adherence to CBH policies and procedures so that all work is of the highest quality and delivered in the most culturally competent and cost-effective manner.

Promote and manage diversity and acceptance within CBH and with all members and stakeholders by honoring and respecting their individuality, dignity and rights.

Offer suggestions and develop solutions to help promote effective and efficient work processes and innovative programs.

Actively participate in required meetings and complete all mandatory trainings.

Maintain high levels of advocacy and member confidentiality to ensure the success of CBH and our mission.

Assist in assuring both internal and external program integrity by being alert to and reporting suspected instances of provider and employee fraud, waste, or abuse.

Essential Functions :

Work requires the ability to analyze and interpret health care business and/or clinical data. Work requires the ability to work well in a team environment and to be self-motivated, while providing guidance and support to team members. Work requires the ability to communicate clearly and accurately in both verbal and written modalities concisely describing problems, solutions, specifications, and plans. Candidates for this role should demonstrate understanding of provider contracting, standard clinical models, and grouping of claims at the event level.

Analyze and interpret health care business and/or clinical data

Demonstrate understanding of standard clinical models and grouping of claims at the event level

Perform reviews of data reports with the ability to identify non-compliance with VBP payment or clinical guidelines

Synthesize utilization data and adherence to regulatory and contractual guidelines, and prepare written reports for proposed VBP, Alternative Payment Arrangements (APA), and special projects

Contribute to the VBP unit’s published materials including Provider Toolkit and news blast articles

Act as liaison with other CBH departments including Provider Operations, Medical Affairs, Compliance, Quality, Clinical Management, and other Finance units in the development, implementation, and monitoring of program standards and payment strategies

Stay current with applicable CBH, State, and Federal policies and regulations and National Committee for Quality Assurance (NCQA) policies related to Value Based Purchasing

Participate in VBP unit presentations including provider training activities

Conduct internal trainings and act as a resource for staff from both CBH and the Department of Behavioral Health and Intellectual disAbility Services (DBHIDS)

Represent the VBP unit at internal, provider, and stakeholder meetings as assigned

Review, contribute to, and maintain databases (e. g. Smartsheet, payment calendars, logs, etc.)

With administrative support, monitor and respond to the VBP unit emails

Complete at least two VBP related trainings per calendar year

Other duties as assigned

Position Requirements:

Education: Master’s degree in social services field.

License/Certification: N/A

Relevant Work Experience: Minimum of 5 years of work experience in the human services or public health field. Prior experience with value based payment models and/or regulatory/healthcare compliance is preferred.

Skills:

Proficient meeting facilitation skills

Ability to work independently

Strong verbal and written communication skills

Solid negotiation skills

Ability to summarize findings and prepare reports in a concise manner

Ability to understand and analyze clinical charts

Proficiency in Microsoft Office

Core Competencies:

Teamwork and Collaboration : Build and sustain relationships with co-workers and stakeholders and support efforts and deliverables. Encourage unity and help remove barriers to productivity and success.

Respect : Treat each other and our members and stakeholders with respect and sensitivity, recognizing the importance of diversity.

Member Centric : Focus on the needs of our members by providing value-added services, promoting strong relationships and going beyond basic expectations to achieve the best possible outcomes.

Honesty and Integrity : Be open and honest in all we do. Maintain the highest level of integrity at all times.

Commitment to Service Excellence : Challenge ourselves to be forward-thinking and committed to providing total member and stakeholder satisfaction, first-in-class service and high quality, innovative programs.

Compassion and Empathy: Demonstrate a deep appreciation for another’s situation and point of view. Pay attention to emotional cues, listen effectively and show an exceptional level of caring about each person’s perspectives and circumstances.

Problem Solving : Build and implement logical solutions to resolving challenges/issues by using individual knowledge and experience while taking resources, constraints and CBH values into consideration.

Initiative and Self-Directed : Proactively manage time and resources in a way that ensures that all work is done in the most efficient manner while identifying and implementing initiatives without interventions from co-workers, supervisors or stakeholders.

Flexibility and Adaptability : Adjust approaches and behaviors in order to meet the constantly changing environment head-on and accomplish CBH and individual goals. Strive to adapt to, accept and embrace change within areas of responsibility.

Communication : Effectively and appropriately share thoughts, ideas and information - both written and oral. Respectfully listen to co-workers and stakeholders to gain a full understanding of issues/situations.

Work Conditions (including travel, overtime required, physical requirements and occupational exposure):

Must be able to travel within Philadelphia and surrounding counties.

Regularly requires walking, standing, stooping, bending, sitting, reaching, pushing, pulling and/or repetitive wrist/hand movements for various lengths of time throughout the day.

Ability to utilize computers and office equipment to complete daily work responsibilities.

Regularly works inside in areas that are adequately lighted and ventilated. Some fluctuation in temperature. No protective equipment routinely needed.

Must be able to adapt to continuous changes/demands of the job.

Equal Employment Opportunity: CBH provides equal employment opportunities to all qualified individuals without regard to race, creed, color, religion, national origin, age, sex, marital status, gender identity, sexual orientation, individual genetic information or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function.

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