Assistant Vice President of Payer Engagement

at  HCA Healthcare

NOTE: ELIGIBILITY FOR BENEFITS MAY VARY BY LOCATION.

You contribute to our success. Every role has an impact on our patients’ lives and you have the opportunity to make a difference. We are looking for a dedicated Assistant Vice President of Payer Engagement like you to be a part of our team.

JOB SUMMARY AND QUALIFICATIONS

At the direction of the RVP of Operations: Collaborate with IRC, Case Management / URS, Parallon, PCA, Legal and other HUB resources, to oversee the strategic resolution and prevention of denials, payment discrepancies and other claims adjudication issues from HCA’s managed care book of business.
Note: This is a senior level position within the Company, with significant revenue responsibilities and requiring a high-level understanding of payer contracts, policies and HCA’s internal tools and data bases and the ability to think strategically and offer innovative solutions to payers and to meet with senior level payer management to increase the efficiency of the payer’s claims collection process.

General Responsibilities:

• The primary responsibility of the AVP is to be a leader in the centralized Payer Engagement “HUB” and with dedicated resources to direct the strategic resolution and prevention of denials, and payment discrepancies in the Managed Commercial, Exchange, Managed Medicare and Managed Medicaid books of business that consists of 3700 contracts and generating over 15B in revenue.
• The AVP is responsible for ensuring complete and accurate preparation of a phased implementation of the unit to ensure solutions are ROI driven.
• The AVP will oversee the successful engagement between payers and Parallon/HCA on all underpayments, overpayments and denial activity resulting from contract and payer policy interpretation variances, as well as rate load model and modeling variances.
• The AVP will be responsible for ensuring HUB attendance on all SSC payer calls (according to HUB rollout), and represent HCA at national payer meetings and participate in all DRT activities.
• The AVP will direct the HUB’s involvement in denial and discrepancy management activities, from avoidance (by providing recommendations of robust contract protections to PCA) to information gathering (via regular meetings with URS / Case Management and SSCs, maintenance of Denial Activity Tracker form and participation in DMAT) to resolution (via JOCs and other problem-solving interfacing with the MCOs) to disputes (via involvement with PCA Legal, SSC Legal and other dispute resolution processes).
• The AVP will collaborate with existing resources across the company (Parallon, Legal, Case Management, DMAT, CDI, HIM, PCA, SPS, PI, HPG)
• The AVP will develop strong working relationships with senior and local PCA leadership, Group CFOs, Division leadership, and SSC/Parallon leadership.
• The AVP will maintain current knowledge of State and Federal regulations, laws and legislative agendas regarding the healthcare industry, paying particular attention to those that involve healthcare reform, managed care, ERISA and health insurance.
• The AVP will practice and adhere to HCA’s mission and values statement and code of conduct, and attend all required ethics and compliance training and retraining (including but not limited to Code of Conduct, Information Protection and Physician Relationship requirements).
• The AVP will perform other duties as may be assigned or requested by the SVP, VP, Division CEO, Division CFO, ASD and hospital leadership.

Must Have:

• 10+ Years of relevant experience
• Bachelor’s Degree (Master’s Preferred)
• Supervisory experience
• Significant Managed Care contracting experience, specifically in the areas of financial analysis, payment methodologies, contract language and negotiations.
• Significant Revenue Cycle management experience, specifically in the areas of accounts receivable, denials, and underpayments.
• The candidate must be fluent in such systems as Word (including editing documents via redline features), Excel, Pivot Point tables and PowerPoint presentations, etc.

WHAT QUALIFICATIONS YOU WILL NEED:

• Bachelors Degree
  HCA Healthcare (Corporate), based in Nashville, Tennessee, supports a variety of corporate roles from business operations to administrative positions. Like our colleagues in any HCA Healthcare hospital, our corporate campus employees enjoy unparalleled resources and opportunities to reach their potential as healthcare leaders and innovators. From market rate compensation to continuing education and career advancement opportunities, every person has a solid foundation for success. Nashville is also home to our Executive Development Program, where exceptional employees are groomed to take on CNO- and COO-level roles in our hospitals. This selective program focuses on ethics, leadership and the financial and clinical knowledge required of professionals at this level of the industry.
  HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
  “Good people beget good people."- Dr. Thomas Frist, Sr.
  HCA Healthcare Co-Founder
  We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Assistant Vice President of Payer Engagement opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring!
  We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status

• The primary responsibility of the AVP is to be a leader in the centralized Payer Engagement “HUB” and with dedicated resources to direct the strategic resolution and prevention of denials, and payment discrepancies in the Managed Commercial, Exchange, Managed Medicare and Managed Medicaid books of business that consists of 3700 contracts and generating over 15B in revenue.
• The AVP is responsible for ensuring complete and accurate preparation of a phased implementation of the unit to ensure solutions are ROI driven.
• The AVP will oversee the successful engagement between payers and Parallon/HCA on all underpayments, overpayments and denial activity resulting from contract and payer policy interpretation variances, as well as rate load model and modeling variances.
• The AVP will be responsible for ensuring HUB attendance on all SSC payer calls (according to HUB rollout), and represent HCA at national payer meetings and participate in all DRT activities.
• The AVP will direct the HUB’s involvement in denial and discrepancy management activities, from avoidance (by providing recommendations of robust contract protections to PCA) to information gathering (via regular meetings with URS / Case Management and SSCs, maintenance of Denial Activity Tracker form and participation in DMAT) to resolution (via JOCs and other problem-solving interfacing with the MCOs) to disputes (via involvement with PCA Legal, SSC Legal and other dispute resolution processes).
• The AVP will collaborate with existing resources across the company (Parallon, Legal, Case Management, DMAT, CDI, HIM, PCA, SPS, PI, HPG)
• The AVP will develop strong working relationships with senior and local PCA leadership, Group CFOs, Division leadership, and SSC/Parallon leadership.
• The AVP will maintain current knowledge of State and Federal regulations, laws and legislative agendas regarding the healthcare industry, paying particular attention to those that involve healthcare reform, managed care, ERISA and health insurance.
• The AVP will practice and adhere to HCA’s mission and values statement and code of conduct, and attend all required ethics and compliance training and retraining (including but not limited to Code of Conduct, Information Protection and Physician Relationship requirements).
• The AVP will perform other duties as may be assigned or requested by the SVP, VP, Division CEO, Division CFO, ASD and hospital leadership