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Value-Based Care Operations Specialist (Attribution & Performance)
Greensboro, NCPosted 1 weeks ago
Full Time (40 Hours/Week)onsitesenior
Job Description
The Attribution Reconciliation Coordinator is the dedicated subject-matter expert and operational owner of Triad HealthCare Network’s (THN) patient-to-provider attribution and reconciliation program. This role is critical to THN’s success in value-based care contracts. The coordinator will operationalize, maintain, and continuously improve standardized attribution reconciliation policies, workflows, and tools (including Salesforce) across all major payers (e.g., UnitedHealthcare, Humana, Aetna, Cigna, BCBS, ACO Reach, Devoted, HTA). The position drives discrepancy resolution, ensures compliance with payer-specific attribution rules, reduces financial risk exposure, and strengthens network integrity by aligning payer attribution logic with THN’s clinical and operational realities.
Essential Job Function
- Own the full lifecycle of attribution reconciliation: identification, investigation, documentation, resolution, and prevention of discrepancies across all payers.
- Lead development, version control, and real-time accessibility of the attribution policy, key decisions, workflows, how-to guides, and training materials in Salesforce.
- Serve as the primary escalation point and coordinator for high-volume workflows (e.g., Termed providers (6,476+ cases), No Utilization, Out-of-Network, Group vs. Individual NPI attribution).
- Monitor monthly attribution metrics (volume of discrepancies, resolution rates, aging, financial impact) and report performance against goals.
- Conduct regular audits of attribution processes and payer reports; recommend and implement improvements to hierarchy rules, exclusion criteria, and reconciliation windows.
- Partner with Network Operations, Physician Liaisons, Analytics, Contracting, and external payer teams to resolve complex cases and update attributed NPIs as needed.
- Salesforce Panel Management
- Help design and deliver training for internal teams and provider practices on attribution policy, Salesforce tools, and payer-specific requirements.
- Support the build-out and ongoing enhancement of Salesforce as THN’s Provider Relationship Management and attribution workflow platform.
- Proactively stay ahead of evolving payer attribution methodologies and industry trends to future-proof THN processes.
Education
- Required: Associate's Degree
Experience
- Required:
- 5+ years of progressive experience in healthcare network management, payer contracting, patient attribution/revenue cycle operations, or population health
- Proven expertise in data reconciliation, workflow optimization, and policy implementation in a value-based care or clinically integrated network environment
- Advanced proficiency in Salesforce (or similar CRM/PRM platform), Excel, PowerPoint, and healthcare analytics/reporting tools
- Deep understanding of payer attribution methodologies (e.g., PCP hierarchy, claims-based vs. enrollment-based logic, scheduling compliance rules)
- Exceptional analytical, communication, and cross-functional collaboration skills — comfortable presenting to executives, providers, and payer partners
- Demonstrated ability to manage multiple high-priority projects and timelines in a fast-paced environment
- Salesforce Experience
Licensure/Certification/Listing
Preferred: PMP certification and/or Lean Six Sigma certification