Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The VP of Health Plan Economics supervises, reviews, and manages the development and implementation of the Alignment Provider Management Report (APMR). Designs and develops ad hoc reports to support Provider Contracting and Network Development, analysis of product line profitability, gross margin, and expansion market analytic support.

GENERAL DUTIES/RESPONSIBILITIES
1.   Develops and manages Alignment Provider Management Report (APMR) for current and expansion markets.
2.   Departmental Partnerships:
a.   Works with Alignment IT department to assist in the programming and mapping of various financial and key performance indicators within APMR
b.   Works with Alignment Accounting staff to reconcile and verify the integrity of APMR yearly and monthly financial data to the General Ledger
c.   Works with Alignment FP&A team to incorporate budget data and assumptions into APMR.
d.   Works with Alignment Claims department to validate the integrity of claim payment within APMR
e.   Works with Alignment Provider Contracting and Network Development staff to analyze contract rate trending impact and anomalies (hospital modeling, SNF/home health modeling, others).
f.   Works with Alignment UM and Clinical operations department to validate and reconcile key authorization admit and bed day metrics to actual paid claim data.
3.   Supports Regional VP’s in providing analysis of monthly APMR data and ad hoc reporting of key performance indicators.
4.   Supports finance and operations in developing predictive KPI’s to better forecast and manage the business of Alignment.
5.   Maintains and enhances finance business intelligence tools such as Qlik Sense and Power BI
6.   Supports claims trend assumptions for budgets and bids, validation of MLR on bids compared to historical trends, unit cost trends for inpatient/outpatient costs
7.   Oversee risk pools/gain shares/provider incentives and manage quarterly or annual payments
8.   Oversees Monthly Operating Reports (MOR) for clinical and network teams, highlighting MLR trends, utilization and unit cost trends, out of area claims, areas of opportunities and risks
9.   Oversees configuration and administration of monthly capitation payments to providers
10.   Plans, prioritizes, assigns, supervises and reviews the work of staff responsible for providing APMR services.
11.   Provides or coordinate staff training as necessary; work with employees to correct deficiencies; implement discipline procedures.
12.   Works with all levels of staff to direct, assist, and explain the APMR process as needed.

Supervisory Responsibilities:

Oversees assigned staff. Responsibilities include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.

Job Requirements:

Experience:

• Required: Minimum of 10 years of experience in financial/data analysis. Minimum of 10 years of managerial experience

• Preferred: 5+ years of experience in healthcare.

Education:

• Required: Bachelors degree

• Preferred: MBA

Specialized Skills:

• Required:

Knowledge of principles and practices of finance administration in accounting, budgeting, and auditing.
Understanding of CMS Premium payment methodologies to MA Health Plans. Understanding MMR documentation, premium payment calculations, Risk adjustment Factors (RAF), other premium adjustments, and file layout.
Understanding of CMS provider payment methodologies (DRG, RBRVS, etc.)
Understanding of operations, services and activities within a Data Warehouse environment (Claim Data, Membership, Eligibility, and Revenue Data, etc.)
Understanding provider capitation contracts, development of capitation rates, contract carve outs, performed comparative analysis to Fee For Service.
Exposure and ability to use Actuarial studies related to IBNR and LDS
Understanding of provider contracts for medical groups, independent physicians, and hospitals.
Understanding of payment methodologies for Hospitals (DRG, Per Diem, % of Billed, etc.) and Physicians (RBRVS, FFS, Capitation, etc.) and other ancillary providers.
Develop new analysis and approaches to the use of data that allow fresh insights into the business of the company
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
Report Analysis Skills: Comprehend and analyze statistical reports.

Licensure:

• Required: None

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1 While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2 The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $198,219.00 - $297,329.00

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.