- Overall management of the AMSURG managed care portfolio
- Advance enterprise initiatives and integration
- Negotiating contractual and reimbursement terms with market payors
- Ability and desire to build the team and talents within Managed Care, including attracting, developing, and retaining individuals
- Monitor state and federal legislation related to payment initiatives, policy changes that could impact negotiations with health plans
- Provide leadership to the integration of new joint ventures, affiliations and partnership arrangements
- Assess and review risks and opportunities across the enterprise related to payment reform, bundled payments, value-based payments, alternative payors, etc.
- Develop tools and techniques that advance pricing objectives
- Develop internal operating reports that quantify departmental and geographic portfolio performance
- Establish and disseminate contracting guidelines with respect to third party payor contractual terms, reimbursement, provider enrollment and product participation.
- Conduct annual reviews of provider contracts
- Analyze claim trend data and/or market information needed to support contract negotiations
- Review and present financial data, utilization trends and patient mix needed to negotiate and re-negotiate payor contracts
- Maintain knowledge of payor products, enrollment statistics, and trends
- Understand and stay abreast of issues and events that may have an impact on business and industry
- Work with the team on maintaining client satisfaction through internal and external communication
- Identify contracting / payor disputes that may require legal action
- Travel overnight and locally as needed
- Regular and reliable attendance
- Other duties as assigned
- Responsible for adhering to Information Security Policies and ensuring Envision is as secure as possible.
To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. The requirements listed below are representative of the knowledge, skills and/or abilities required.
- A strong ability to collaborate with physician partners and field operations; recognizes these partners are the life-blood of the business. Able to develop and manage relationships both internally and with these partners
- Successfully navigate a matrix environment and be seen as a key team player and business partner to other stakeholders for their perspective making the overall business optimize its performance
- Possesses a high adversity quotient and is able to handle confrontations with poise and efficiency
- Excellent written and oral communication skills, confident and impactful presenter
- Driven by values and unimpeachable integrity and leads by example; able to manage dynamics around the maintenance and utilization of confidential information
- Master’s degree preferred
- Eleven (11+) years relevant experience required to include supervisory experience, significant managed care contracting experience with demonstrated ability in the areas of financial analysis, payment methodologies, contract language and negotiations
- Equivalent experience considered