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Description

This position is incentive eligible.

Introduction

The AVP of Payor Initiatives serves as the strategic and and tactical leader for the interpretation, development, operationalization, management, and support of Physician Services’ (PSG) provider-based government and commercial value-based payer programs. The programs the AVP will have oversight for include but are not limited to: MACRA/MIPS, 21st Century CURES, Centers for Medicare and Medicaid Innovation (CMMI) projects; Accountable Care Organizations (ACO); Advanced Alternative Payment Models (AAPM); Medicare Advantage; and commercial payer value programs. This position will have particular emphasis on overseeing these programs for providers whose specialties are primarily hospital based, including but not limited to: Critical Care, Pathology, Adult and Pediatric Hospital Medicine, Adult and Pediatric Emergency Medicine, Anesthesia, and hospital-based Sugical specialties. Additionally, the AVP provides strategic planning, oversight, and management for CMS annual data submissions via multiple modalities (registries, QCDRs, eCQMs), develops and implements processes supporting reconciliation of submissions and data exchange between PSG and payers, and directs the evaluation and management of provider and entity (TIN) eligibility for government and other payer programs. This position requires maintaining extensive subject matter expertise and comfort with presenting to and working with external regulatory and advocacy organizations.

The AVP leads the implementation and support planning for the VBC program impact of new hospital-based provider acquisitions, divestitures, and joint ventures. Must have expert-level data and reporting skills with the ability to work with comprehensive data sets and develop reports based on a large array of tools, both internally developed and provided by payer partners, and must be able to quickly analyze data to determine opportunities, needed interventions, and best practices. Further responsibilities include providing leadership and oversight for program education; leading external audit processes; and facilitating internal audit engagements at least annually. This position requires exceptional communication skills, an adaptive leadership style, a focus on collaboration and team-driven results, and the ability to work effectively in the rapidly changing payer reimbursement space.

Job Summary and Qualifications

• Provides strategic and tactical leadership for the interpretation, development, operationalization, management, and support of Physician Services’ (PSG) provider-based government and commercial value-based payer programs in the hospital-based specialties space

• Directs and supervises the development of processes and procedures that ensure successful compliance/completion of requirements for value-based payer programs and develops action plans as needed for successful program reporting

• Builds and leads a high performance cross-functional team focused on providers with hospital-based specialties

• Develops and supervises the development of reports and analytics that measure program and provider performance and are easily consumable by all levels of the organization

• Develops and directs data submissions processes for multiple government and commercial payer programs

• Oversees collaborations and leads development processes with business partners to build operational tools that support value-based payer programs

• Develops and manages vendor relationships for vendors providing services to support value-based payer programs

• Oversees the value-based payer programs due diligence and onboarding process for all hospital-based provider acquisitions including pre-acquisition risk assessments and indemnification recommendations, transition management, and post-acquisition performance

• Leads the planning and execution of government and commercial value-based payer programs for hospital-based provider divestitures

• Models and facilitates excellent working relationships with multiple internal business partners and develops and maintains strong partnerships with enterprise, group, and division operations

• Leads and serves as a subject matter expert for external audit processes

• Leads and facilitates internal audit engagements at least annually

• Serves as a value-based payer programs consultant to HCA Physician Services Group task forces, committees, and projects relating to payer performance initiatives

• Manages multiple on‐going projects and preparation of presentations of findings and recommendations

• Able to mentor, influence, and manage through highly matrixed reporting relationships

• Commits to the success and financial well-being of HCA by challenging others to excel and holding themselves and others accountable for achieving results

• Demonstrates a sophisticated understanding of organizational and social dynamics within the organization and navigates successfully to achieve stakeholder objectives and goals

• Practices and adheres to the “Code of Conduct” philosophy and “Mission and Value Statement”

QUALIFICATIONS:

• KNOWLEDGE, SKILLS, & ABILITIES – This position requires the following:

• Previous extensive experience working with the analysis and implementation of government and/or commercial payer value-based programs such as MACRA/MIPS, Centers for Medicare and Medicaid Innovation (CMMI) projects; Accountable Care Organizations (ACO); Advanced Alternative Payment Models; Medicare Advantage; commercial pay for performance programs, Meaningful Use, PQRS, Core Measures, etc. required; experience supporting these programs for hospital-based providers highly desired

• Detailed working knowledge of hospital and provider healthcare operations and clinical informatics required

• Expert level Excel skills and previous development experience with business intelligence and analytics tools (such as Business Objects, MicroStrategy, Tableau, etc) required

• Minimum 3 years’ prior experience developing and scaling enterprise-wide programs with technology dependencies required

• Ability to quickly develop and continuously maintain extensive subject matter expertise and demonstrated confidence in communicating expertise to all levels of HCA and external business partners

• Excellent working knowledge of electronic medical records, medical terminology, ICD-10, CPTII coding, and medical coding and billing processes

• Demonstrated ability to build diverse teams with varying skill sets and skilled in leading cross-functional project teams in delivering complex and high profile organizational initiatives

• Project Management: Skilled in project planning, task prioritization, effectively manages resources, outcomes measurement, and tracking. Takes initiative and exercises good judgment.

• Maintains comprehensive knowledge of payer and regulatory requirements with ability to work effectively under pressure and adapt to changing priorities.

• Keeps abreast of industry trends and guides teams to adapt to meet evolving needs of payers, government programs and the healthcare industry.

• Advanced analytical and problem solving skills with the ability to quickly draw conclusions and make recommendations required

• Strong teamwork skills and comfort working in a highly collaborative environment; this is a high profile and fast paced team with extensive intra- and inter-team collaboration requirements

• A comfort, or even preference, for an environment of discovery and uncertainty

• Exceptional communication skills with ability to clearly and effectively communicate to all levels of the organization

• Ability to perform work, special assignments, and tasks under only very general supervision

• Ability to work under pressure and overtime (evenings and weekends) as needed

• Travel up to 25% may be required

EDUCATION: Master’s Degree in Business, Healthcare Administration, Analytics, or clinical area required

EXPERIENCE: Minimum 7 years of related experience with government or commercial value-based programs, quality improvement, leadership, program development or healthcare quality. At least 5 years progressive leadership experience running cross-functional teams.

Benefits

HCA Healthcare, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.

• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.

• Free counseling services and resources for emotional, physical and financial wellbeing

• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)

• Employee Stock Purchase Plan with 10% off HCA Healthcare stock

• Family support through fertility and family building benefits with Progyny and adoption assistance.

• Referral services for child, elder and pet care, home and auto repair, event planning and more

• Consumer discounts through Abenity and Consumer Discounts

• Retirement readiness, rollover assistance services and preferred banking partnerships

• Education assistance (tuition, student loan, certification support, dependent scholarships)

• Colleague recognition program

• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)

• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits (https://careers.hcahealthcare.com/pages/employee-benefits-and-rewards)

Note: Eligibility for benefits may vary by location.

Our teams are a committed, caring group of colleagues. Do you want to work as a(an) AVP Payor Initiatives where your passion for creating positive patient interactions are valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise!

Physician Services Group (https://careers.hcahealthcare.com/pages/physician-services) is skilled in physician employment, practice and urgent care operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers. We are HCA Healthcare's graduate medical education leader. We provide direction for over 260 exceptional resident and fellowship programs. We focus on carrying out value-added solutions. These solutions help physicians deliver patient-centered healthcare. We support HCA Healthcare's commitment to the care and improvement of human life.

HCA Healthcare has been recognized as one of the World's Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our AVP Payor Initiatives opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.