Vp, Network Strategy

The VP of Network Strategy is responsible for integrating payer strategies with CARTIs strategic objectives. The primary goal is to maximize net revenue and ensure compliance through contracting, contract payment, recovery analysis, recovery management, analysis of payer performance, and participation with multiple stakeholders to implement new payer-directed or government-directed reimbursement models and quality measurement models that impact reimbursement. Directs and oversees, in coordination with the SVP of Revenue Cycle, CFO and other stakeholders, the implementation of systems, processes, and procedures to provide the highest level of revenue capture and integrity aligned with payer requirements. This includes evaluation of current and potential services and systems. This position is critical in establishing, developing and maintaining payer partnerships and vendor partnerships for Data, Remittance, and Collection Agency services among other contractual partnerships. This position has direct impact on revenue and cash flow integrity, technology integrations and financial strategy.JOB SPECIFIC DUTIES AND RESPONSIBILITIES:Operational LeadershipDefines, establishes, and maintains overall sound strategies regarding agreements with payers.Provide strategic planning and direction of innovative long-range strategy to achieve initiatives, priorities and goals of Revenue Cycle department. Ensure the strategy aligns with the overall mission and vision of CARTI.Drive execution and transformational change within Revenue Cycle team to ensure effective, efficient, sustainable, compliant, and leading edge operations to contribute to the financial success of CARTI.Build and maintain relationships with Revenue Cycle leadership/partners and team members creating an environment where CARTI values are continuously exceeded.Oversee new systems, products, and business implementations for Revenue Cycle team. Assess organizational strengths and weaknesses to recommend enhanced operational model.Lead standardizing, creating and sustaining a common culture and high performing operation aligned with CARTI priorities and serving the needs of our patients.Motivate, facilitate, mentor, and coach team to deliver high quality, cost effective services. Facilitates the ongoing learning, well-being, professional satisfaction and development of staff through training, work assignments, increased responsibility, and mentoring.Assist in Development of procedures and policies for the operation of Revenue Cycle department, process and team members.Maintain a strong, collaborative relationship and provide clear communication with all team members.Present data, strategies, and progress toward goals in various governance management forums.Lead a cross functional team of department leaders for ongoing revenue cycle improvement and mitigating the risk of denials (denials prevention).Directs and manages contract negotiations with carriers and maintains payer relationships.Assures timely updates, renegotiation and revision of commercial payer agreements.Analyze contracts and prepares recommendations for agreement participation and non-participation.Works closely with internal colleagues to improve contract reimbursement and overall success of contract adherence by payer, including timely payments.Manages critical external communications, including documentation, certification and file management related to commercial payer relationships.Manages payer credentialing.Process Improvement and AnalyticsDeliver financial results through process improvement initiatives in line with the comprehensive organizational strategy.Lead and manage complex Revenue Cycle projects, working with key stakeholders across CARTI.Coordinate and implement revenue cycle initiatives, including identifying and assembling resources when necessary.Develop and manage initiatives to ensure the operations of the denials management team is in line with organizational goals. Initiatives will be implemented by cross-functional teams.Interpret and oversee the implementation of complex rules and regulations governing insurance, appeal activities, trends, etc. and will make recommendations.Actively engages, partners, and influences organizational leaders to ensure that operations and processes remain consistent and emulate best practices.Work collaboratively with key stakeholders throughout CARTI to ensure that revenue and reimbursement are properly reported and support the services provided.Performance MonitoringEstablish and maintain ongoing performance monitoring.Liaison with relevant stakeholders to develop priority projects and provide expert advice on best practice processes.Actively monitor operational performance to anticipate and meet the needs of leadership.Meet with department leaders to review and interpret revenue cycle reports to drive accountability and transparency in performance.Ensure revenue cycle data quality monitoring and related training. Monitor work unit compliance with internal controls and develops remediation plans to address identified control weaknesses.Revenue Integrity and ComplianceResponsible for ensuring reimbursement is optimized and processes are put in place to minimize revenue leakage.Ensures that organizational integrity and regulatory standards are maintained in all Revenue Cycle policies, procedures and processes. Ensure that all team members know and understand their roles related to regulatory compliance.Proposes, Implements, and Integrates Systems and Processes to facilitate ongoing Revenue Integrity and Compliance.Responds to reimbursement-related audits from commercial and government payers, shares findings and performance improvement opportunities, and ensures mitigation of negative impacts from audit findings.OTHER JOB REQUIREMENTS:This individual must be able to work under pressure and be proactive as well as resourceful.Confidentiality is crucial for this role.Expert verbal and written communication skills, strong decision making ability and attention to detail are equally important.This multi-tasker must be exceedingly well organized, flexible, display a high level of professionalism and enjoy the administrative challenges of supporting a clinic of diverse people and patients.Loyalty and respect for all physicians, patients and co-workers is mandatory for this position.SUPERVISORY RESPONSIBILITY:Leads in clinical negotiations related to necessary carve outs and exclusions to contractsAssists with development and maintenance of tools and staff guidelinesPromote integration of areas and divisions, promote collaborationManages Multiple Teams (including but not limited to: Credentialing, Denial/Risk Mitigation, Direct Partnerships, and other units assigned as reporting the VP of Network Strategy).Manages Remote Contract Labor and Agreements as Necessary to Operational Initiatives.EDUCATION, CERTIFICATION, LICENSURE, REGISTRATION:Bachelors Degree in Healthcare, Management or related field.EXPERIENCE, KNOWLEDGE, SKILLS and ABILITIES:Minimum of 7-10 years experience working in a healthcare related environment.Demonstrated success in leading, implementing, and managing financial performance of payer contracts.Proven ability to successfully partner with payers and to collaborate effectively with peers within an organization in order to achieve positive results.Significant knowledge of contractual, administrative, health insurance and operational issues related to managed care organizations, physician groups, and health systems.Demonstrated ability with process improvement.Strong technical background and proven ability to convert operational and implement various systems, workflows, and interfaces to facilitate appropriate charge capture and error mitigation.Demonstrate and promote system thinking, including strong understanding of interrelationships of departmental delivery systems and the ability to collaborate across service lines and affiliates to ensure integrated delivery of services.Knowledge of change management.Ability to implement and lead cross functional teams.Ability to manage large strategic projects.REASONING ABILITY:Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.Ability to interpret a variety of instructions furnished in written, oral, or schedule form.INTERPERSONAL SKILLS:Must interact and communicate both verbally and in written form.Must interact and exchange information regarding patients with physicians and other departmental personnel, and outside agencies on a frequent basis while respecting the confidentiality of patient information.PHYSICAL DEMANDS:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.While performing the duties of this job, the employee is regularly required to talk or hear.The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.Specific vision abilities required by this job include close vision and the ability to adjust focus.WORK ENVIRONMENT:The work environment described here are representative of those an employee encounters while performing the essential functions of this job.This position involves potential exposure to infectious diseases. Team members are offered appropriate vaccinations and safety training.