AVP Payment Compliance in Nashville, TN at Parallon

Date Posted: 4/3/2018

Job Snapshot

Job Description

Parallon believes that organizations that continuously learn and improve will thrive. That’s why after more than a decade Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future. As one of the healthcare industry’s leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized revenue cycle services.


GENERAL SUMMARY OF DUTIES:
Provide leadership in developing and implementing strategic initiatives related to the review of denial and discrepancy management, including the development of operational standards and integration of new technology to enhance processes, selection and implementation of trending analyses, development of standard escalation and education processes and policies, and assurance these initiatives meet company strategies. Provide management and corporate oversight related to operational aspects of the Payment Resolution and Appeals functions within Payment Compliance.

DUTIES INCLUDE (but not limited to):

  • Work with the Parallon Business Performance Group Executives to identify, develop and implement key management strategies related Payment Compliance Resolution and Appeals functions within the SSC revenue cycle payment compliance areas of responsibility.
    • Manage Payment Compliance processes to identify, prioritize and provide oversight to ensure we are implementing consistent and comprehensive processes throughout the SSCs.
    • Ensure processes are established to identify trends by payor and across multiple SSCs to ensure most effective method of pursuit to include escalation through dispute resolution.
    • Perform onsite operational assessments of SSC payment compliance processes and make recommendations for improvement or implement action plans.
    • Develop, implement and monitor key performance indicators to ensure that the SSC Payment Compliance teams are operating effectively.
    • Monitor performance indicators to identify areas for best practice.
    • Create, administer and maintain process for post denial write off dispute resolution escalation
    • Work with VP SSC Operations and VP Dispute Resolution on any issues that cross the functional areas of responsibility.

  • Provide management of technology solutions supporting operational areas of responsibility. Direct IT&S related to the SSC needs, development of ROI for system changes, prioritization and alignment of resources with needed enhancements related to all associated systems.
  • Manage any new issues that arise related to changes in processes, payor contracts, changes in the company’s portfolio, changes in the technologies being used by the SSCs, and any internal or external inquiries related to Payment Compliance / Payment Resolution and Appeals functions.
  • Work with revenue cycle Parallon Business Performance Group Executives to ensure that Payment Compliance process is meeting the needs of internal and external customers, the department and the Company.
  • Lead the SSC Management Teams through selection, implementation, and monitoring of vendors used to assist with Denial, Overpayment and Underpayment recovery efforts.
  • Promote the department as a service organization and continuously help to identify and satisfy the needs of its customers.
  • Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
  • As needed, provide assistance to the VP of Revenue Cycle Operations in any area requested.

Job Requirements

Education

B.S. in Business Administration or Healthcare Administration or equivalent work experience.

Experience
Minimum of 10 years experience in financial, operational and system processes related to Healthcare A/R Management.
SSC management experience preferred.
Some travel may be required.