We have a hybrid work arrangement.
EOE: race/color/religion/sex/sexual orientation/gender identity/national origin/disability/vet
JOB SUMMARY:
Coordinates with a network of hospital and health system managed care, revenue cycle, and compliance professionals. Provides in-depth research, support, education, and advocacy around issues of healthcare reimbursement and compliance, including managed care (commercial, Medicaid, and Medicare Advantage), TennCare, workers' compensation, payment innovations, changes in methodologies, and program integrity. Utilizes data, when possible, to demonstrate impacts of payer issues. Assists in the creation of educational and professional development opportunities for member hospitals related to current and emerging topics in managed care, revenue cycle, and compliance.
ESSENTIAL FUNCTIONS OF THE JOB :
1. Provide in-depth research, support, education, and advocacy for members around issues of healthcare finance and reimbursement. Serve as a resource and respond to member inquiries on these issues in a timely and effective manner.
2. Provide subject matter support for various THA workgroups.
o Aid in the development of agendas based on current issues, trends, regulatory advisories, member feedback, etc.
o Help create presentations as needed for the workgroups to foster communication and discussion.
o Ensure compliance with all laws, especially paying close attention to federal antitrust regulations.
o Maintain notes from the workgroup meetings and share them with workgroup members.
o Follow up on and assist members in resolving issues as applicable.
3. Provide in-depth research, support, education and advocacy for members around healthcare compliance issues and program integrity. Provide a statewide focal point for compliance education and compliance officers. Respond to member queries on these issues.
4. Maintain payer scorecard system and inpatient rehabilitation facility (IRF) payer database. Review data for trends and make recommendations to address identified issues and ways to improve THA's use of payer data. As applicable, respond to member inquiries regarding payer scorecard system or IRF payer database.
5. Review proposed state and federal legislation and assist in drafting talking points for the advocacy teams. Provide feedback about potential impacts to hospital finances and operations resulting from proposed bills and assist in gathering feedback from members, including the applicable workgroups, to assist with impact analyses.
6. Must have the ability to adapt to a changing work environment and meet challenges presented throughout the day.
7. Must be available for out-of-town travel approximately 10 percent of the time, be able to drive an automobile and maintain a valid driver's license. Must travel both within and out of the state for various meetings as needed.
8. Must be available in the office during regular office hours unless job responsibilities require otherwise, or hybrid work arrangement is in place.
ORGANIZATIONAL STRUCTURE: (Positions reporting directly to this position.)
None
GUIDANCE & DIRECTION: (Policies, precedents or procedures that guide this work.)
1. Reimbursement and compliance rules (commercial or governmental) must be known, followed, and considered
Educational and experience Requirements Needed to Perform the Duties of the Job:
1. Educational requirement:
Bachelor's degree in accounting, finance, or other related field required.
2. Minimum of five years' experience in health care required. Background experience and knowledge should include:
-Detailed knowledge of hospital revenue cycle and/or managed care—commercial, Medicare Advantage, Medicaid,
and workers' compensation, including:
Reimbursement methodologies
Financial analysis
Legal/contractual issues
Reimbursement audits
Investigation and resolution of payment errors
Operational issues
Measuring contract performance
-Hospital and/or health system operations experience desired
-General knowledge of the following as it relates to hospitals:
Accounting/auditing
Billing and collections
Healthcare compliance
Health information management
Utilization management
Quality & accrediting bodies
3. Experience with the following:
Managing or conducting reimbursement analysis/negotiation
Contractual language
Operationalizing financial arrangements
Identifying and resolving issues involving reimbursement, hospital operations, and healthcare compliance
Building and managing relationships with managed care payers/outside entities
Skills Required to Perform the Duties of the Job:
1. In-depth understanding of hospital or healthcare operational, technical, regulatory, and contractual issues and procedures.
2. Must be analytical and able to ascertain and process facts related to a potential concern and use good judgment as to whether problems actually exist or need to be escalated.
3. Must have strong problem-solving skills and be able to find solutions through detailed research, strategic thinking, and effective communication.
4. Ability to understand both sides of a dispute and move toward resolution/mitigation of issue.
5. Ability to work constructively with payers and maintain positive working relationships while advocating for hospital members.
6. Must have excellent written and verbal communication skills.
7. Must have the ability to take complex issues and explain them in an appropriate manner based on the knowledge level of the audience.
8. Must be able to think through creative ways to solve problems. Must be able to navigate and negotiate complicated multi-faceted issues within complex relationships. Needs to be able to understand the interconnectedness of the healthcare finance environment.
9. Must be proficient in Microsoft Word, Outlook, Excel, PowerPoint, and Teams.
Compensation details: 115000-125000 Yearly Salary
PI63716ac59f62-25405-37106154
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