Assistant Director - PHO
Reporting directly to the Executive Director of the PHO, the Assistant Director will work closely and collaboratively with the Insurance payors as well as serve as a liaison to the medical staff and stakeholders.
RESPONSIBILITIES :: Assisting in the Negotiation of physician managed care contracts, analytics and financial modeling. Coordinating physician enrollment in managed care plans. Insuring compliance of managed care companies with negotiated contracts. Following up and resolving payment issues with payors. Liaison between physicians and payors. Scheduling, coordinating and documentation for all PHO related meetings. Developing and managing budget for PHO. Compiling information for membership regarding changes and updates in the reimbursement environment. Participate in the development of HSS Alternative Payment Methodologies (ie: Episode Based Bundled Payments) to be offered to large employers and insurers. Work with PHO Executive Director to develop strategies to sell Alternative Payment Methodologies to employers and insurers. Collaborate with Employer and Strategic Partnership Department to create new product offerings to large employers.
EXPERIENCE, COMPETENCIES, AND PERSONAL CHARACTERISTICS : Solid experience (minimum 5 years) in any combination of contract negotiations, resolving payment(claims) issues, financial analysis/planning for/in a hospital or Health Insurance company. Major teaching/surgical hospital experience or health plan experience is highly desirable. Minimum of 5 years of supervisory, team-related experience is required. Hospital Service Line experience highly desirable. Technology savvy: excellent understanding of processes and databases; proficient with Excel, Word, and PowerPoint. Demonstrated understanding of contract negotiations, finances, operations, regulations, strategic planning, and the hospital/healthcare industry, as well as external environmental forces, is required. The ability to influence and motivate others, as well as work collaboratively within a multi-stakeholder environment is required.
EDUCATION: Associate degree required Bachelor’s degree preferred