ResponsibilitiesJob SummaryUnder general direction of the Director, Payer Contracting, Physician, and with significant latitude for independent judgment, the Assistant Director (AD), Payer Relations & Contracting is responsible for the central oversight and coordination of payer-related issues across the professional enterprise. The AD acts as a liaison between URMC Payer Contracting & Reimbursement and the United Business Office (UBO), ISD, Compliance, hospital PAO, department Administrators and payer representatives/managers/directors. The AD ensures payers are held accountable for contractual terms, e.g. reimbursement, administrative process, clinical edits, etc. The AD develops & implements policies and procedures related to functional areas. In managing all responsibilities, the AD, seeks to continually improve quality & customer responsiveness. AD serves as back-up administrator to the Director, Payer Contracting.Key Functions and Expected PerformancesUnder general direction of the Director, Payer Contracting & with significant latitude for independent judgment:40% Responsible for coordination and central management of operational issues associated with payer contracts across the professional enterprise. Establishes and maintains effective working relationships with third-party payer representatives to ensure appropriate and timely reimbursement. Interacts at all levels within the payer environment up to and including network Vice Presidents and Medical Directors. Provides oversight and financial analysis of ongoing payer performance and ensures timely resolution of issues through early identification & escalation to director when necessary. Tracks/trends all issues and financial impact to the enterprise. Maintains expert, up-to-date thorough knowledge of third-party payer reimbursement, contract rules & regulations. Meets regularly with key insurers to assure contractual and/or reimbursement arrangements are adhered to, and that identified issues move productively toward resolution. Evaluates contract effectiveness in terms of opportunities, risks, financial and operational feasibility. Participates in professional associations & development activities to remain informed of developments in the field. Disseminates information to URMC senior administrators, departments & UBO.30% Directs the development of analyses for financial & non-financial decision-making. Is the liaison with UBO Assistant Directors, Compliance, ISD, & Medical Staff Office. Understands overall billing operations, including coding. claim production & acceptance by payer, line-item payment, adjustment, clinical edit & denial. Recommends strategies for performance improvement. Offers education, interpretive assistance, and guidance to UBO, URMFG & departmental leadership. Provides leadership, continuous support, communication, & problem-solving strategies to stakeholders to proactively identify needs and operational improvements. Develops and executes strategic plans to facilitate program development & process improvement. Advises Director re payer contractual, administrative, operational & fiscal activities, opportunities/risks. Is the owner/administrator of external vendor for PR issue-tracking software (IssueTrak).15% Develops & implements enterprise-wide operating procedures re payer performance & issue resolution. Analyzes situations/incidents, prepares, & delivers briefings to communicate recommendations to management. Prepares FYE variance report for URMFG CFO & senior finance director for accounting of recoverable revenues/liabilities. Facilitates meetings with UBO AD’s & Revenue Advisors. Communicates with Office of Compliance when indicated to ensure appropriateness of professional billing. Prepares and presents data to Senior Leadership as needed. Serves as functional area’s liaison with internal auditors. Identifies, presents, & implements operational improvements in functional areas within URMFG Administration and clinical departments.15% Provides direct supervision, advice, & guidance to subordinate staff. Hires, evaluates performance, recommends salary adjustments, performs other personnel actions. Develops functional orientations, plans & implements training for staff. Encourages positive communication and cooperation. Represents department on various internal and external committees. Performs other duties as assigned.Qualifications:Bachelors and five years relevant experience.The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion to advance the University’s mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.How To ApplyAll applicants must apply online.EOE Minorities/Females/Protected Veterans/DisabledPay RangePay Range: $108,483 - $162,725 AnnuallyThe referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.Apply for Job
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