Job Description

Job Description

Job Description

Acting as a strategic advisor to executives, this role translates complex clinical and financial data into actionable insights that optimize performance and profitability. Partnering with payer contracting, finance, revenue cycle, clinical operations, and value-based care teams, this role evaluates contract performance, forecasts outcomes, and identifies opportunities for improvement. The ideal candidate blends technical expertise with strong communication and influencing skills to align diverse stakeholders and advance organizational success in a rapidly evolving healthcare landscape.

CORE RESPONSIBILITIES:

• Lead the development and execution of value-based contracting strategies in partnership with contracting, revenue cycle, value-based care, and clinical leadership, leveraging advanced analytics and data science to drive enterprise-wide results.
• Serve as a strategic advisor to the contract negotiations team, providing forward-looking analysis of historical and projected performance, and delivering actionable insights on contract proposals and counterproposals.
• Partner with the Value-Based Care Team to evaluate clinical performance and risk adjustment data across commercial and government payer models, identifying opportunities to optimize outcomes and inform future contracting strategies.
• Design and enhance supplemental payer data feeds to maximize clinical performance reporting and ensure accurate capture of all risk-adjustable conditions.
• Analyze reimbursement trends and variances by payer and contract, providing recommendations to senior leadership to inform strategic decision-making.
• Develop and maintain advanced forecasting methodologies for non–fee-for-service payments, including PMPM, quality incentives, and shared savings, ensuring accurate financial projections.
• Build, refine, and oversee predictive models to evaluate contract performance, identify improvement opportunities, and support strategic initiatives.
• Review and validate payer financial settlements, reconciling interim and year-end reports against clinical and operational performance, and advising leadership on resolution of discrepancies.
• Deliver executive-level insights and reporting on payer performance, profitability, and emerging risks to support strategic decision-making.
• Lead cross-functional solutions with Contracting, Finance, and Revenue Cycle teams to address complex reimbursement issues and implement sustainable solutions.
• Assess the impact of new payer policies, regulations, and programs, providing guidance to leadership on potential effects on reimbursement and operational performance.
• Maintain subject matter expertise on industry trends, reimbursement models, and payer policies, serving as a thought partner to executive and clinical leadership.

• Maintains strict confidentiality in alignment with HIPAA (Health Insurance Portability and Accountability) guidelines and InterMed policies.
• Perform other duties to support the mission, vision and values of InterMed.

MISSION AND VALUES:

• Follows InterMed’s mission to provide patient-centered primary care, putting the patient first to deliver high quality, high value care.
• Provide the highest quality care to our patients with a level of service that exceeds their expectations.
• Maintain a positive attitude and always treat our patients and each other with dignity and respect.
• Insist on honesty and integrity from each other and our business partners.
• Make teamwork a core component of our relationships between physicians, staff, and patients.
• Embrace change to better serve our patients.
• Use business practices that feature individual accountability and group responsibility to ensure delivery of high value healthcare.
• Have fun as we carry out our mission to serve.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Education:
  • 5–7+ years of progressive healthcare experience, particularly in payer contracting, value-based care strategy, or healthcare finance, with demonstrated strategic responsibility.
  • Bachelor’s degree in healthcare administration, business, finance, or a related field required; Master’s degree or higher preferred
• Experience:
  • Leadership / Strategic Influence: Proven experience leading cross-functional initiatives across multiple departments and influencing executive-level decision-making to drive organizational strategy.
  • Advanced Analytics / Modeling: Demonstrated ability to develop forecasting tools, predictive models, and scenario analyses to guide payer contracting strategies and optimize value-based care performance.
  • Exceptional analytical skills with the ability to identify subtle trends in data, develop hypotheses, and translate findings into actionable insights.
  • Advanced analytical expertise with experience in predictive modeling, deductive reasoning, and scenario analysis to support strategic decision-making.
  • Strategic and creative thinker, capable of identifying subtle trends, developing hypotheses, and designing methods to analyze complex data sets and defend actionable conclusions.
  • Proven ability to lead cross-functional collaboration, working effectively with stakeholders across healthcare, data science, finance, legal, and population health.
  • Proficiency in data analytics tools and techniques, including SQL, Microsoft Excel, and data visualization platforms (e.g., Tableau, Power BI), with experience querying data directly from enterprise data warehouses.
  • Experience with clinical and claims data, including EMR systems, ICD-10, and CPT coding, and the ability to translate this data into actionable contracting insights.
  • Deep knowledge of healthcare reimbursement methodologies, including fee-for-service, capitation, shared savings, and other value-based payment models.
  • Excellent written and verbal communication skills, with the ability to synthesize complex analyses into executive-level recommendations.
  • Strong organizational and project management skills, including the ability to prioritize multiple initiatives, manage deadlines, and drive cross-functional projects to completion.
• License/Certifications:
  • N/A

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