Oversees compliance of managed care companies and payment rules with negotiated contracts.
Works closely with other members of the Managed Care team, Patient Financial Services, and/or Central Billing Office to identify trends and opportunities in outstanding Accounts Receivables for both PHO providers and facilities.
Responsible for ensuring reports and updates (i.e. A/R, denials, etc.) are disseminated to departmental staff. This includes working with Patient Financial Services and other departments on the implementation and maintenance of departmental dashboard.
Escalates issues as necessary to payer contacts for resolution as well as HSS contracting team. Recommends escalation as appropriate to senior management.
Provides feedback on trends/patterned issues to Managed Care team to aid in negotiation and implementation of fee-for-service and value-based payer contracts across HSS and PHO.
Assesses contract administrative terms and payer policies to advise leadership accordingly on measures of contract performance.
Ensures key stakeholders are communicated to on contractual obligations, emerging trends stemming from contract performance, payer policy changes, and other related topics
Maintains up to date knowledge on the healthcare market and timely initiatives
Implement departmental policies, protocols and systems to enhance efficiency and effectiveness of workflows
Possess strong leadership skills and demonstrate capability to inspire staff to pursue excellence in goals and productivity; capable of coaching and improving staff in need of professional development. Places high priority on overall team performance.
Additional responsibilities as required to accomplish departmental goals.
EXPERIENCE, COMPETENCIES, AND PERSONAL CHARACTERISTICS :
Experience ( minimum 7+ years ) with payer or provider contracting and/or revenue cycle management. Major teaching/surgical hospital experience or health plan experience is highly desirable.
Experience with EPIC or other comparable EMR systems preferred.
Experience with Salesforce preferred.
Experience managing and leading a professional team.
Experience dealing with physicians and their office/billing staff.
Possesses key payer contacts and knowledge of payer resolution processes.
Knowledge of the healthcare industry and payer reimbursement methodologies (both hospital and physician).
Ability to work independently and collaboratively to solve complex problems
The ability to influence and motivate others, as we
Benefits
Health insuranceEquity / stock options
Additional Information
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HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment.
Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise.
Emp Status
Regular Full time
Work Shift
Compensation Range
The base pay scale for this position is $112,000.00 - $170,875.00. In addition, this position will be eligible for additional benefits consistent with the role. The salary of the finalist selected for this role will be determined based on various factors, including but not limited to: scope of role, level of experience, education, accomplishments, internal equity, budget, and subject to Fair Market Value evaluation. The hiring range listed is a good faith determination of potential compensation at the time of this job advertisement and may be modified in the future.
Hss · New York, NY