HERC: Metro New York & Southern Connecticut Assistant Director, Managed Care Contracting in New York, New York
Employer Name: Columbia University
Job Type: Officer of Administration Regular/Temporary: Regular Hours Per Week: 35 Position Summary Reporting to the Chief Contracting Officer, the Assistant Director will be responsible for high-level decision support analyses and financial modeling, management of escalated claims issues, and implementation, and management of ColumbiaDoctors Managed Care Contracts. Responsibilities Operations Under the direction of the Chief and Associate Director, performs high-level, sophisticated reporting, modeling, and analyses using claims data extrapolated from Epic and Experian to maintain assigned project portfolio. Prepares detailed analysis of data to support financial modeling to provide recommendations to leadership in terms of payer negotiations for contracts, amendments, or the resolution of claims issues. Oversees the preparation and synthesis of data from a multitude of sources to perform comparison analysis of claims revenue by different contracts (Rack and Stack Report) for presentation to Senior Leadership. Serve as Subject Matter Expert for all standardized and special projects relating to the interface of the EMR and Contracting. Working with internal stakeholders including Clinical Revenue Office, clinical academic departments, EpicTogether, prepare recommendations on Epic workflows and improvements to current processes to optimize revenue collection while maintaining the integrity of contractual exceptions and EMR rules for billing services. Research, analyze, and negotiate escalated claims issues resulting from managed care payer policy, errors in contract set-up by payers, contract disputes, and other sources. Review trend data to identify areas of opportunity for optimization. Under the supervisor of the Associate Director, oversees escalated claims process, representing the interests of clinical academic departments and the Clinical Revenue Office in negotiations with the clinical payers. Serves as point of contact for contracted payers, internal Managed Care staff, and external stakeholders in the resolution of general inquiries and escalated issues including rates, billing procedures, or contracting concerns and issues. Performs ad-hoc financial analysis and modeling related to business development and strategic planning initiatives for the enterprise as requested. Strategic Under the direction of the Associate Director, participates in the implementation and execution of unit goals that are strategically aligned with the overall Managed Care business unit as well as the FPO organization, mission, and vision. Collaborates with senior leadership to develop tools and strategies for effective analysis, presentation, and communication of complex topics including, but not limited to informal and formal presentations for various audiences, feedback channels, senior leadership/stakeholder presentations and reports, vendors, etc. Prepares analysis for formal written communications (reports, presentations, emails). Ensures relevant communications are effectively cascaded to the various interest and stakeholder groups as needed. People Completes personnel actions as needed. Assists in the execution of recruitment, succession planning, professional development, and employee engagement. Ensures compliance with Human Resources and departmental policies and procedures including local, state, federal, and regulatory standards, as they apply to respective job functions. Promotes staff professionalism and performance with coaching, training, and feedback. Mentors staff in individual and team accountability, modeling behavior, and demonstrating best practices/techniques. Demonstrates self-development and keeps current on a variety of practice operations topics. Establishes a culture of coaching and mentoring to facilitate continuous professional development and maintain an efficient patient-centered environment ensuring accountability, quality patient care, and patient satisfaction. Identifies and mitigates any roadblocks to performance, evaluates the effectiveness of development. Collaborates with HR to set objectives and/or develop remediation/action plans. Compliance & Other Conform to all applicable HIPPA, Billing Compliance, Medicare Advantage plan compliance, and other pertinent regulations. Serves on committees, task forces and work groups as assigned. Completes other assignments or special projects as assigned. Minimum Qualifications BA/BS or equivalency in education and experience. Minimum 5 years of related experience (i.e., working with managed care companies on the professional, non-facility side) An equivalent combination of education, training, and experience may be considered. Computer proficiency in MS Office (Word, Excel, and PowerPoint) and Adobe Acrobat Professional version. Proficiency in Cognos Reporting, Experian Contract Management, and Epic Physician Billing is required as well as demonstrated ability to learn new software. Ability to collate, organize, synthesize and interpret complex data from multiple sources to create comprehensive data analysis and reporting required. Excellent written and oral communication skills, including the ability to explain complex topics to a wide variety of audiences. Strong analytical and data interpretation skills. Strong interpersonal and organizational skills are a must. Expertise in managed care physician revenue cycle payer policies. Ability to successfully work multiple priorities with varying timelines both independently and in a team setting. Preferred Qualifications Master?s degree EPIC PB experience preferred. 5 years of experience working in an academic medical center is preferred. Other Requirements Ability to work indoors in an environmentally controlled environment with a degree of dust, noise, odors, etc. without undue discomfort. Ability to perform sedentary work that primarily involves sitting or standing for a long period of time, working on a computer. Competencies Patient Facing Competencies Minimum Proficiency Level Accountability & Self-Management Level 3 - Intermediate Adaptability to Change & Learning Agility Level 3 - Intermediate Communication Level 3 - Intermediate Customer Service & Patient-Centered Level 4 - Advanced Emotional Intelligence Level 3 - Intermediate Problem Solving & Decision Making Level 4 - Advanced Productivity & Time Management Level 3 - Intermediate Teamwork & Collaboration Level 3 - Intermediate Quality, Patient & Workplace Safety Level 3 - Intermediate Leadership Competencies Minimum Proficiency Level Business Acumen & Vision Driver Level 2 - Basic Performance Management Level 3 - Intermediate Innovation & Organizational Development Level 2 - Basic Equal Opportunity Employer / Disability / Veteran Columbia University is committed to the hiring of qualified local residents.