About the position
This role is critical to the success of the Revenue Cycle Support Services department, and requires the individual to be skilled at utilizing a collaborative approach, work effectively and efficiently, working cross-functionally with all Driscoll Health System operational areas, helping to get consensus across operational areas, and helping to ensure that Driscoll Health System maintains compliance across the organization. This individual should demonstrate strong analytical skills as it relates to organizational activities and revenue. This individual will manage and supervise the activities related to payer contracts in the Revenue Cycle Support Services department. This may include all staff as well as Epic contract applications. This individual may assist with the analysis, preparation and submission of System government reports to the Texas Health and Human Services Commission, Third Party auditors to HHSC and other agencies as necessary. The role includes coordination of all insurance contract negotiations, renegotiations and correspondence with contract representatives for Driscoll Children’s Hospital, Driscoll Transport, Driscoll Physician Group.
Responsibilities
- Maintain utmost level of confidentiality at all times.
- Adhere to system policies and procedures.
- Demonstrate business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
- Serves on project teams performing tasks assigned by the Director.
- Lead and monitor project teams under the Director’s supervision.
- Provide project updates to appropriate individuals.
- Research and analyze operational data as it relates to Revenue Cycle.
- Participate in organizational development as it relates to Revenue Cycle process improvement strategies.
- Evaluate new products and emerging technologies regarding their suitability within the current environment.
- Supervise requirements for external audits including Commercial, OIG, and RAC audits.
- Negotiate and renegotiate managed care contracts and proposals.
- Oversee and coordinate communications with administration, legal, operations, and financial representatives.
- Participate in pediatric insurance and managed care related collaborations.
- Maintain a comprehensive payer and managed care intelligence database.
- Negotiate single patient agreements with non-contracted payers.
- Provide Director with payer report cards on a quarterly basis.
- Recommend updates to managed care contracts and business terms.
- Propose alternate legal language and coordinate contract changes.
- Evaluate opportunities and financial terms for contracts.
- Maintain chronology of managed care proposals and counter proposals.
- Assess legal risks in the context of contract provisions.
- Draft responses and fulfill requests for additional information needed by managed care plans representatives.
- Complete the development of proposals in response to managed care plan requests.
- Provide strategic and financial judgment necessary to achieve profitable growth with payers.
- Review models that quantitatively evaluate plan financial impact of proposals.
- Resolve contracting issues and provide interpretation of managed care contract language.
- Review and maintain enrollment of Medicaid and Medicare active provider enrollment.
Requirements
- Bachelor’s degree in Business Management or Computer Information Systems preferred.
- Proficiency in Microsoft Excel, PowerPoint and Word.
- Prior experience with EPIC, 3M, ICD-10 or Midas is a plus.
- 5+ years of experience in a hospital or healthcare setting required.
- Strong oral and written communication skills.
- Strong organizational skills.
- Ability to multi-task and work on multiple projects simultaneously.
