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Posted Date 4 days ago(9/24/2021 6:32 AM)
How you move is why we’re here. ® Now more than ever. Get back to what you need and love to do. The possibilities are endless...   Now more than ever, our guiding principles are helping us in our search for exceptional talent - candidates who align with our unique workplace culture and who want to maximize  the abundant opportunities for growth and success.   If this describes you then let’s talk!   HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment. Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise.     Director, Payor Strategy and Contracting       Reporting directly to the Assistant Vice President, Payor Strategy and Contracting, the Director Payor Strategy and Contracting will be primarily responsible for the negotiation, implementation and oversight of all payor contracts.  The Director will work closely with the analytics team to model all contract proposals including fee for service and value based arrangements (i.e. shared savings, bundles, etc.).  They will work closely with the Account Management Team to trouble shoot contract operational issues and assist where necessary to bring them to resolution using their understanding of the underlying contracts as well as by leveraging their payor relationships.  The Director will provide managerial oversight to the Payor Contract Manager.    RESPONSIBILITIES: - Meets with senior leadership to ascertain strategic payor contracting goals. - Analyzes payor contract proposals in conjunction with the analytics team to ensure contracts meet financial goals. - Negotiates contracts ensuring financial and strategic goals are translated into contractual language accordingly. - Works closely with the legal team to review and redline contracts as appropriate. - Ensures internal stakeholders are aware of contract terms and reimbursement rates and that contract terms are appropriately communicated/translated into front and back end processes. - Works closely with the revenue cycle teams to ensure contracts are loaded appropriately into billing and decision support systems. - Works closely with the Account Management team, CCS team (i.e. UM/clinical denials team) and Patient Financial Services and/or the Central Billing Office to identify trends and opportunities in outstanding Accounts Receivables. - Escalates issues as necessary to payer contacts for resolution. In conjunction with Account Management, recommends escalation as appropriate to senior management. - Identifies trends/patterned issues to aid in contract re-negotiations. - Assesses contract administrative terms and advises leadership accordingly on measures of contract performance. - Maintains up to date knowledge on the healthcare market and reimbursement trends. - Possesses strong leadership skills and demonstrates capability to inspire staff to pursue excellence in goals and productivity; capable of coaching and improving staff in need of professional development. Places high priority on overall team performance. - Additional responsibilities as required to accomplish departmental goals.      
Job ID
2021-14707
Emp Status
Regular Full-Time
Shift
Days
Posted Date 1 week ago(9/20/2021 1:03 PM)
How you move is why we’re here. ® Now more than ever. Get back to what you need and love to do. The possibilities are endless...   Now more than ever, our guiding principles are helping us in our search for exceptional talent - candidates who align with our unique workplace culture and who want to maximize  the abundant opportunities for growth and success.   If this describes you then let’s talk!   HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment. Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise.     Director, Account Management   Reporting directly to the Assistant Vice President, Account Management, the Director of Account Management will be primarily responsible for the identification, escalation and resolution of hospital or PHO physician-related payor issues. These include, but are not limited to contract or enrollment issues impacting billing/reimbursement, administrative issues impacting operations, and communication with key stakeholders. This position provides oversight to Managed Care Coordinators and serves as a liaison to the hospital and PHO Payor Contracting teams.   RESPONSIBILITIES: - Oversees compliance of managed care companies and payment rules with negotiated contracts. - Works closely with other members of the Account Management team, CCS team (i.e. UM/clinical denials team) and Patient Financial Services and/or the Central Billing Office to identify trends and opportunities in outstanding Accounts Receivables for both the PHO and hospital entities. - Responsible for ensuring pertinent reports and updates (i.e. A/R, denials, etc.) are disseminated to departmental staff. This includes working with Patient Financial Services and other departments on the implementation and maintenance of departmental dashboard - Escalates issues as necessary to mid-level payer contacts for resolution as well as HSS contracting team. Recommends escalation as appropriate to senior management. - Provides feedback on trends/patterned issues to Contracting team to aid in negotiation and implementation of fee-for-service and value-based payor contracts across HSS and PHO - Assesses contract administrative terms and advises leadership accordingly on measures of contract performance - Ensures key stakeholders are communicated to on contractual obligations, emerging trends stemming from contract performance, payor/policy changes, and other related topics - Maintains up to date knowledge on the healthcare market and timely initiatives - Advise on/implement departmental policies, protocols and systems (i.e. Salesforce) to enhance efficiency and effectiveness of workflows - Possess strong leadership skills and demonstrate capability to inspire staff to pursue excellence in goals and productivity; capable of coaching and improving staff in need of professional development. Places high priority on overall team performance. - Additional responsibilities as required to accomplish departmental goals.      
Job ID
2021-14669
Emp Status
Regular Full-Time
Shift
Days
Posted Date 1 week ago(9/20/2021 12:56 PM)
How you move is why we’re here. ® Now more than ever. Get back to what you need and love to do. The possibilities are endless...   Now more than ever, our guiding principles are helping us in our search for exceptional talent - candidates who align with our unique workplace culture and who want to maximize  the abundant opportunities for growth and success.   If this describes you then let’s talk!   HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment. Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise.   Payor Enrollment Coordinator Managed Care   The Payor Enrollment Coordinator will be primarily responsible for coordinating physician and non-physician enrollment into the Managed Care Plans.  This position will work independently and as a valued team member supporting the coordination of all operational aspects of the enrollment/credentialing program, including organizing, compiling key informational data and executing processes and procedures related to internal and external credentialing/appointment, re-credentialing and profile maintenance.  Assignments are planned and executed with considerable independence in conformance with established policies, regulations, and laws. Duties and Responsibilities The duties include, but are not limited to: - Initiates and coordinates the acquisition and receipt of enrollment/credentialing documentation from new and existing providers; provides follow-up and problem resolution as required.   - Coordinates the processing, distribution, and management of all credentialing and accreditation documents for affected providers.   - Collaborates with internal departments (Patient Access, Medical Staff, Physician Practice Management etc.) to ensure smooth on-boarding of providers into HSS PHO - Assist in the maintenance of accuracy and completeness of internal credentialing database (Cactus). - Review payer plan applications returned to department for accuracy and completeness, troubleshooting as needed.   - Plan, implement and maintain delegated credentialing processes/status with insurance companies. - Assist in ensuring that provider participation in the payer plans and CAQH is current, accurate and up to date.   - Assist with for inputting credentialing information into the departmental credentialing system, as necessary to support the Credentialing process.   - Must actively process forms, requesting payer applications, maintaining file system, following up on issues and troubleshooting problems.   - Maintains and ensures strict confidentiality of files and databases.   - Other duties as assigned.  
Job ID
2021-14668
Emp Status
Regular Full-Time
Shift
Days