SummaryWe are seeking a highly organized, analytical, and relationship-driven Manager, Value-Based Care Operations to support quality initiatives, operational processes, compliance activities, reporting functions, and data management acrossAccountable Care Organization (ACO) programs. This role serves as a key liaison between ACOs, participating provider groups, healthcare organizations, EMR vendors, and internal stakeholders to drive operational excellence, quality performance, and regulatory compliance.
The ideal candidate brings experience in healthcare operations, value-based care, population health, quality reporting, or healthcare analytics and enjoys leveraging data to solve problems, improve processes, build strong relationships, and support the success of complex healthcare programs.
Who You Are:You are a healthcare operations professional who thrives in a fast-paced, collaborative environment and enjoys working at the intersection of quality improvement, data analytics, provider engagement, and operational excellence. You bring strong analytical skills, sound judgment, and a customer-focused approach to building trusted relationships with providers, affiliates, vendors, and internal stakeholders.
You are motivated by improving processes, supporting performance initiatives, and helping ACO, population health, and value-based care initiatives operate effectively.
The Ideal Candidate Will Have Experience In- Accountable Care Organizations (ACOs)
- Medicare Shared Savings Program (MSSP) environments
- Population health and value-based care programs
- Healthcare operations and quality reporting
- Provider networks, physician groups, or health systems
- Healthcare analytics, reporting, and performance improvement
You Will Be Successful in This Role If You- Enjoy analyzing data, identifying trends, and solving operational challenges.
- Are comfortable analyzing complex healthcare data, identifying trends, resolving reporting discrepancies, developing recurring reports and dashboards, and translating data into actionable insights that support operational, quality, and performance initiatives.
- Are comfortable working with EMR/EHR systems, reporting tools, and large healthcare datasets.
- Can effectively balance multiple priorities while maintaining a high level of accuracy and attention to detail.
- Build strong partnerships through collaboration, communication, and exceptional customer service.
- Are proactive, adaptable, and driven to improve processes and outcomes.
Essential Duties & ResponsibilitiesQuality & Performance Management- Coordinate and monitor EMR and quality report delivery, ensuring timely distribution and follow-up on outstanding items.
- Educate ACO participating group operators and providers on quality measures, performance metrics, and reporting expectations.
- Research and resolve quality reporting gaps while collaborating with affiliate back-office teams to improve data accuracy.
- Compile and validate Social Determinants of Health (SDOH) data for regulatory and program reporting requirements.
- Support Promoting Interoperability (PI) communications and follow-up activities.
- Pull, analyze, and distribute monthly reports from electronic medical record systems.
- Review, compile, and verify monthly quality and performance reporting packages before distribution.
Billing & Reporting Operations- Ensure billing bifurcation reports are delivered accurately and on schedule.
- Collaborate with EMR vendors and external teams to investigate and resolve reporting discrepancies.
- Communicate effectively with stakeholders regarding reporting issues, corrections, and status updates.
Operational Process Management- Maintain and update the ACO Operations Manual, ensuring procedures and workflows remain current and compliant.
- Identify, document, and implement new operational processes as organizational needs evolve.
- Coordinate stakeholder input and support process improvements across multiple workstreams.
- Audit, maintain, and manage Specialty Building tracking processes and associated databases.
Vendor & Program Support- Support operational activities, including preparing external-facing materials and coordinating timely, secure data submissions through designated SFTP processes.
- Review monthly invoices and volume reports for accuracy and provide recommendations for approval.
Compliance & Regulatory Support- Coordinate recurring compliance activities, including submission of vendor, TIN, and board member listings.
- Support reporting and documentation requirements to ensure compliance with organizational and regulatory standards.
Relationship Management & Customer Service- Serve as a trusted point of contact for ACO participating groups, providers, and vendors.
- Build strong working relationships through responsive communication, professionalism, and proactive problem-solving.
- Deliver exceptional customer service while balancing multiple priorities and stakeholder needs.
- Facilitate collaboration across departments to support operational excellence and the successful implementation of initiatives.
QualificationsQualifications Sought (Required)- Bachelor's degree in Healthcare Administration, Business Administration, Public Health, Health Information Management, or related field.
- 3-5 years of experience in healthcare operations, quality reporting, healthcare analytics, population health, value-based care, or a similar healthcare environment.
- Advanced Microsoft Excel skills, including experience working with large datasets, Pivot Tables, XLOOKUP/VLOOKUP, data validation, reconciliation, trend analysis, reporting, and data analysis.
- Hands-on experience working with EMR/EHR systems and healthcare reporting data.
- Experience analyzing, validating, and distributing operational and quality reports.
- Experience working directly with external affiliates, providers, vendors, and internal stakeholders.
- Proven experience managing multiple projects, priorities, and deadlines in a fast-paced environment.
- Strong analytical, problem-solving, critical thinking, written communication, and verbal communication skills.
- Exceptional organizational skills and attention to detail.
- Ability to build and maintain productive relationships with providers, affiliates, vendors, and cross-functional stakeholders.
- Strong customer service orientation and the ability to effectively manage stakeholder expectations.
Preferred Qualifications- Experience supporting Accountable Care Organizations (ACOs), Medicare Shared Savings Program (MSSP), population health, or value-based care programs.
- Experience supporting healthcare quality improvement initiatives and provider performance programs.
- Experience collaborating with EMR vendors and external healthcare organizations.
Knowledge- Familiarity with CMS quality and reporting programs, including:
- Merit-based Incentive Payment System (MIPS)
- Promoting Interoperability (PI)
- Social Determinants of Health (SDOH)
- Knowledge of healthcare quality metrics, provider performance measurement, and regulatory reporting requirements.
- Understanding of operational process improvement and workflow optimization within healthcare environments.
