National Director of Payer Compliance Management (PCM)

United Anesthesia Partners   •  

Dallas, TX

Industry: Healthcare

  •  

5 - 7 years

Posted 35 days ago

This job is no longer available.

Overview

U.S. Anesthesia Partners (USAP) is the largest single-specialty anesthesia practice in the country with over 4,000 clinical providers and associates. By joining our team you will participate in a highly collaborative and dynamic environment. As an organization we are mission focused on delivering the highest quality in patient care and you will be directly supporting our talented clinical team. We extend this same commitment to quality to our associates and supply tools and resources that will ensure we win in the healthcare marketplace and support of USAP.

We are proud of our inclusive people culture that supports our associates to perform at their best. USAP is an equal opportunity employer. Candidates with physician services or related health care experience is a plus. We offer a competitive benefits package.

The National PCM Director will manage the Payer Contract Management team. This leader will ensure that USAP proprietary commercial payer contracts and regional federal payer fee schedules are managed effectively in the USAP contract management system so that the Payer Relations team can enforce contact compliance with third party payers. The director will manage all aspects of how rates are managed within the Centricity Business system and ensure all necessary audit controls are in place. The Team is also responsible for third party payer policy management by reviewing contracted payer policies to ensure operational compliance and communicating updates of policy changes to the appropriate Revenue Cycle Management Operations, Compliance and Payer Relations teams.

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES (include but not limited to):

  • Lead designated team, ensuring all commercial and federal payer fee schedules are loaded into the USAP payer contracting database.
  • Ensure compliance with payer policy billing regulations and monitoring of changes. Effectively communicate with internal compliance, payer relations lead and revenue cycle management operations regarding applicable changes.
  • Manage over and underpayments to and from third party payers.
  • Verify contracted fee schedules are appropriately loaded into the USAP Payer Contract Management System in GE Centricity prior to the fee schedule effective date.
  • Set and manage internal auditing & control process functions regarding payer contract loading protocols are appropriate and being followed
  • Work collaboratively with internal stakeholders and external vendors to define and achieve common payer reimbursement contract loading improvement opportunities.
  • Analyze and monitor financial aspects of existing managed care contracts. Utilize analysis for feedback on contract renewals and renegotiations.
  • Other duties as assigned by management

REPORTING TO THIS POSITION:

  • 3-4 FTEs

Qualifications

JOB REQUIREMENTS (Knowledge, Skills and Abilities):

  • Uses knowledge of health plan operations, knowledge of contract requirements and critical thinking skills to make independent decisions and use problem solving abilities to resolve contractual and operational issues daily.
  • Understands and interprets payer contract requirements, financial, utilization and statistical reports.
  • Understands medical claims and associated medical coding as well as having a working knowledge of the internal registration and billing systems for physicians
  • Excellent Verbal and Written skills
  • Ability to prioritize work
  • Ability to successfully manage multiple projects at one time
  • Advance Excel skills
  • Strong analytical skills; ability to gather, analyze and report on information from multiple sources (i.e., Billing System, Internet, Payer Contracts)
  • Knowledge of managed care contracts
  • Excellent verbal and written communication
  • Ability to work effectively and independently with staff, physicians and external vendors
  • In-depth knowledge of Commercial, Medicare, Medicaid, Workers Compensation guidelines and billing standards
  • In-depth knowledge of revenue cycle management systems and the ability to adapt prior knowledge to current software
  • In-depth knowledge of financial class setup and payer setup
  • Ability to work effectively and independently with staff, physicians, and external customers
  • Must have strong computer skills with knowledge of Microsoft Word, Excel and PowerPoint
  • Must have a pleasant disposition and high tolerance level for diverse views and opinions
  • Ability to work independently with minimal supervision
  • Ability to motivate diverse personalities within the departments
  • Communicate well with the key department stakeholders in multiple departments to ensure desired results are maintained
  • Ability to read, write, and speak English

EDUCATION/TRAINING/EXPERIENCE:

  • Bachelor's degree required; Master's in business, healthcare administration, or related field is preferred.
  • Significant knowledge of contractual, administrative, health insurance and operational issues related to managed care organizations, physician groups, hospitals and health insurance
  • benefit plan designs.
  • Proven and extensive contracting technical skills; negotiation skills, contract preparation and implementation, financial analysis and rate proposal development, and in-depth knowledge of various reimbursement methodologies.
  • Experience assessing problems & implementing solutions
  • 5+ years' experience in managed care contracting--preferably in hospital-based contracts

US Anesthesia Partners, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics.