Quality and Payor Program Specialist

Schedule

Full-time: 40hrs/wk

Hours: Monday - Friday, 8am - 4:30pm with some flexibility

Hybrid work model - must be on site in York each week

General Summary

Works with Medical Group and/or Hospital, System and Payor resources to ensure organizational awareness, exceptional communication, ongoing maintenance and optimization of pay for performance initiatives, including Commercial voluntary incentive payment programs. Provides project management for selected planning and operational implementation of quality initiatives, developing project work plans, analyzing financial impact and communicating progress and any identified risks. Develops and reports on operational and financial status and opportunity (related to these programs) for the relevant management, Payer Contracting and Finance. Covers all responsibilities for peers in their absence.

Duties and Responsibilities

• Provides project oversight, including planning, scheduling, vendor management, risk assessment, change management, time management, interpersonal leadership skills, and project control.
• Coordinates, collects and maintains appropriate metrics, values and specific contract requirements related to pay for performance incentive plans for risk contracts and government based programs.
• Networks, collaborates, organizes and communicates with multiple and various internal and external interfaces and departments in order to completely capture all necessary pay for performance program related requirements.
• Utilizing a prioritization and alignment method and tool, prepares measures and related results for review by the appropriate multidisciplinary team in order to assign recommendations for leadership decision making.
• Apply process improvement principles and quality improvement tools and techniques to identified processes/systems/ tasks.
• Works with operational leadership to ensure alignment of resources with work effort required.
• Creates timelines and deliverables for workflow development, implementation and monitoring for selected quality measures.
• Develops forms, policies and procedures in cooperation with the Manager.
• Compiles data for and prepares regularly scheduled or special reports, analyses and statements.

Travel Requirements:

• Estimated Amount: - Travel to multiple work sites as required

Qualifications

Minimum Education:

• Bachelors Degree In business or healthcare related field Required

Work Experience:

• Less than 1 year 6 - 12 months Required

Knowledge, Skills, and Abilities:

• Proven outstanding interpersonal skills;
• demonstrated ability to function as a team player.
• Basic computer skills including Microsoft Office products.
• Effective verbal and written communication skills;
• analytical skills;
• ability to work independently and strong problem solving skills.
• Demonstrates initiative in new approaches;
• able to establish and maintain effective relationships with co-workers/organizational departments.

Benefits Offered:

Comprehensive health benefits

Flexible spending and health savings accounts

Retirement savings plan

Paid time off (PTO)

Short-term disability

Education assistance

Financial education and support, including DailyPay

Wellness and Wellbeing programs

Caregiver support via Wellthy

Childcare referral service via Wellthy