Job Details

Company: Highmark Inc.

Job Description:

JOB SUMMARY

We are seeking a dynamic and experienced Director of Reimbursement Strategy and Market Analysis to play a pivotal role in defining and enhancing our reimbursement strategies. The ideal candidate will collaborate with various stakeholders across the organization to develop and execute innovative reimbursement models that align with our strategic objectives. By staying informed about industry advancements in both commercial and government sectors, you will help propel Highmark to the forefront of the healthcare landscape.

ESSENTIAL RESPONSIBILITIES

• Lead departmental functions, including direct involvement in hiring, coaching, performance reviews, and operational organization. Ensure established policies and budgetary guidelines are maintained.

• Develop comprehensive strategies for innovative reimbursement models such as fee-for-service, pay-for-value, bundled payments, and risk-sharing initiatives. Create a 3-5 year roadmap to keep Highmark current with industry trends.

• Utilize a Health Economist perspective to assess and improve reimbursement models, collaborating with stakeholders to design targeted initiatives that support enterprise goals.

• Build and maintain strategic relationships with providers to gauge readiness for change, validate programming concepts, and effectively communicate emerging market trends.

• Take on additional duties as necessary to support the team and the organization.

EDUCATION

Required

• Bachelor's Degree in Business, Finance, Healthcare Administration, or a related field.

Preferred

• Master's Degree in Business or Healthcare Administration.

EXPERIENCE

Minimum

• 7 years in Healthcare, Healthcare Insurance, Consulting, or related fields.
• 3 years in value-based reimbursement and managed care contracting.
• 4 years in research and strategic planning focused on reimbursement and payment model design.

To include:

• 1 year of experience working with technology vendors and service providers.
• 2 years of experience as a Health Economist with an emphasis on health trends.

Preferred

• 5 years of familiarity with alternative care models and reimbursement strategies.
• 5 years of experience in health service delivery quality metrics.
• 5 years in managing large cross-functional projects.
• 5 years of knowledge related to health plan and provider contracting.
• 2 years of understanding provider contract management processes.

LICENSES or CERTIFICATIONS

Required

• None.

Preferred

• None.

SKILLS

• Exceptional written and verbal communication skills, capable of conveying complex ideas effectively.
• Proven ability to manage multiple projects while meeting deadlines.
• Strong autonomous decision-making skills, guiding reimbursement model creation from strategy to execution.
• Advanced analytical abilities complemented by a solid financial background in healthcare economics.
• Quick mathematical proficiency to support real-time decision-making.

Travel Requirement:

• 0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based, with regular travel to various work sites.

Pay Range Minimum: $126,400.00

Pay Range Maximum: $236,000.00

Base pay is determined by a variety of factors including experience, qualifications, and market considerations.

Highmark Health and its affiliates are committed to fostering a diverse environment and prohibit discrimination based on veteran status, disabilities, or any protected category under applicable law.

For assistance regarding website accessibility or the application process, please contact HR Services.

Req ID: J267196