Reports to AMM Director of Administration. Individual is responsible for managing all aspects of operating Government contracts, IPAs and Fiscal Intermediary clients, including maintaining communication with client leadership, physicians, resolving physician grievances, and interface with AMM departments to satisfy the operational needs of the client.
Primary liaison to Government Clients, Providers, Patients and IPA Board of Directors.
Develops and trains all department staff.
Schedules and conducts Client meetings, which may include QA/UR Committee meetings, Credentialing Committee meetings, and other meetings as assigned. These meetings will likely occur after-hours and off-site. Develops agenda items with IPA leadership and AMM Department Managers. Keeps minutes of meetings and maintains action items and monitors follow-up.
Provide ad hoc reports and other projects as assigned or required.
Ensure compliance with all applicable state and federal guidelines and laws, and all health plan directives.
Work closely with AMM department managers to assure that all Client services are performed with the highest quality outcomes.
Work closely with AMM executives and make strategic planning recommendations that achieve IPA goals.
Work closely with Director of Care Management to monitor utilization of health care services and overall quality of care.
Work closely with Finance Director to assist with the oversight of cash transactions, funding and disbursements, including payments from agencies, health plans and capitation and claims payments to physicians and other providers.
Work closely with Provider Network Manager regarding provider office visits, HCC/STARs initiatives, and other provider issues.
Work closely with EDI manger to oversee all Electronic Data Interchange and reporting of data to Clients and health plans.
Work closely with Claims Operations Manager regarding grievances, appeals, and other reimbursement issues.
Work closely with Claims Manager regarding claims reimbursement issues and provider trending.
At the direction of the Clients, work closely with Contract Manager for the initiation and execution of all provider and ancillary agreements. Ability to interpret health plan contract and matrix of responsibility requirements
At the direction of the Clients, work closely with Marketing Director regarding all marketing events throughout the year.
EDUCATION & EXPERIENCE REQUIREMENTS
- Bachelor degree in Health Care Administration or Public Health Administration from an accredited university.
- Six years’ experience in IPA management or comparable managed health care experience.
- Knowledge of applicable state and federal managed care laws and guidelines (AB 1455, Accountable Care Act, HIPAA, Stark, etc.).
- Experience negotiating health plan managed care agreements and physician and provider agreements preferred.
- Ability to manage all aspects of business operations, and effectively manage personnel and various projects within time constraints.
- Effectively interface and successfully cultivate relationships with various business partners; including health plans, hospitals, and health care providers.
- Demonstrated communication, interpersonal, and time management skills. Must be able to make presentations, conduct formal meetings, write business letters and effectively use email to communicate complex ideas.
- Attention to detail and take ownership of assigned tasks.
- Valid driver’s license and/or dependable transportation to work off and on-site is necessary.
- Must be computer literate and knowledgeable in Microsoft Office, with understanding of EMR systems, and IPA management software.