The Director, Revenue Management (Medicare Advantage) will manage the performance analysis and financial reporting for our Medicare Advantage line of businesses. The Director of Revenue Management will work with company stakeholders (Actuary, Impact Analytics, Finance) to oversee the development of the company’s financial outlook for the Medicare Advantage line of business (revenue recognition, FP&A inputs), provide leadership in the prioritization of contracts and resources (eg, field teams, HQ teams), and perform due-diligence on payer reporting and financial reconciliations.
Primary Duties:
- Lead team that oversees the financial analysis of Medicare Advantage value-based contracts. Review payer financial and quality reporting for accuracy and adherence to agreed-upon methodologies.
- Develop financial inputs for our revenue recognition and long range plan (LRP).
- Manage the development and maintenance of financial tools (eg, Market Performance Outlook Reports) to report financial performance and revenue projections to internal and external teams.
- Provides input to key stakeholders on prioritization of contracts for allocation of resources (eg, field teams, app logic, HQ teams).
- Perform due-diligence on payer reporting and financial reconciliation.
- Provide oversight and guidance on ‘service fund audit’ function. Work collaboratively with internal and external stakeholders to adjudicate issues, disputes, and contestations.
- Support payer partnership negotiations by modeling performance and creating recommendations for financial terms.
- Communication of financial outlook to internal and external stakeholders. Provide actionable recommendations for field teams and HQ leadership.
- Oversee network optimization projects for practice portfolio management.
- Other duties as assigned.
Minimum Qualifications:
- Bachelor’s degree in related field or equivalent work experience required.
- 9+ years experience in health economics, finance, and/or value-based care revenue forecasting. Minimum of 5+ years specialization with Medicare Advantage.
- 3+ years management experience within a health care setting (ACO, payer, practice, etc).
- Deep knowledge of value-based care methodologies.
- Deep knowledge of Medicare Advantage methodology and economics (contractings, bidding, P&L management, policy).
- Ability to create and translate complex analysis to executive presentations for senior leadership.
- Advanced ability with Excel / Google sheets and data manipulation skills (eg, SQL/SAS/R).
- Advanced knowledge of Medicare Advantage revenue and claims payment/processing.
- Familiarity with CMS risk adjustment methodologies and payment.
Preferred Qualificatons
- Master’s degree in a relevant subject (MHA, MBA, economics, health policy).
- Actuarial skills (pricing / forecasting).
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 payers, 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 year2 Paid Volunteer Days & 11 paid holidays
12 weeks paid Parental Leave for all new parents
6 weeks paid sabbatical after 6 years of service
Educational Assistant Program & 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.
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