The Senior Manager, Performance Economics (Service Fund Audit) will support the performance analysis and financial reporting for our Medicare Advantage line of business. The Senior Manager of Performance Economics will perform due-diligence on payer reporting and financial reconciliations. In addition, the position will be responsible for working directly with payer partners and across internal teams to remediate data issues.
Primary Duties:
Review payer financial reconciliations for accuracy and adherence to agreed-upon methodologies.
Support for the development and deployment of audit procedures applied to payer data sets.
Partner across teams and with payers to resolve data discrepancies. Project manage the contestation process with support from the legal team.
Collaborate with the Service Fund Audit team to support the build of standard operating procedures, timelines, and workflows to clearly document the end-to-end process that will ensure the accuracy of financial reconciliations and eventual payment to practices.
Ensure transparency of Service Fund audit work for field teams and provide timely updates and timelines to senior leaders and market stakeholders.
Serve as the subject matter expert in interpreting payer agreements to ensure accurate calculation of financial reconciliations.
Support projects relating to portfolio management (eg, practices & contracts) in Medicare Advantage.
Other duties as assigned.
Minimum Qualifications:
Bachelor’s Degree in Healthcare Administration, Business, Public Health, or related field.
7+ years of experience related to the business of healthcare. Minimum of 3+ years specialization within Medicare Advantage.
2+ year management experience.
Deep knowledge of value-based care methodologies.
Deep knowledge of Medicare Advantage methodology and economics (contracting, bidding, P&L management, policy).
Advanced ability with Excel / Google sheets and data manipulation skills (eg, SQL/SAS/R).
Ability to collaborate effectively with cross-functional teams and external partners.
Strong organizational skills with the ability to multitask, prioritize competing demands, and manage time effectively in a fast-paced environment.
Preferred Qualifications:
Master’s Degree in Healthcare Administration, Business, Public Health, or related field
Who We Are:
Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of health plans, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.
What Does This Mean for You?
At Aledade, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work - and who are all united by a shared passion for public health and a commitment to the Aledade mission.
In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members:
Flexible work schedules and the ability to work remotely are available for many roles
Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners
Robust time-off plan (21 days of PTO in your first year)
Two paid volunteer days and 11 paid holidays
12 weeks paid parental leave for all new parents
Six weeks paid sabbatical after six years of service
Educational Assistant Program and Clinical Employee Reimbursement Program
401(k) with up to 4% match
Stock options
And much more!
At Aledade, we don’t just accept differences, we celebrate them! We strive to attract, develop and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.
