DIRECTOR AMBULATORY MANAGED CARE & REVENUE OPTIMIZATION Job Number: 00122608
Job Posting: Jan 31, 2019, 5:18:43 PM Closing Date: Feb 15, 2019, 5:59:00 AM Full-time Shift Start Time: 8:00 A.M. Shift End Time: 4:00 P.M.
Posting Salary : COMPETITIVE
Organization: Health and Hospital Systems
The Director of Ambulatory Managed Care & Revenue Optimization is responsible for management of the ambulatory front-end revenue cycle across the Ambulatory Community Health Network (ACHN). The Director is an ACHN subject-matter expert on revenue cycle operational improvements. The Director will develop optimization strategies and implementation plans in collaboration with ACHN leaders. The Director is responsible for operationalizing effective revenue cycle initiatives, including operationalizing Managed Care contracts and maximizing Healthcare Effectiveness Data and Information Set (HEDIS) bonus incentives. In collaboration with Finance, Patient Support Center, Managed Care and Hospital Information Systems (HIS), the Director is accountable for technical practices, patient enrollment, and achievement of the goals and objectives of assigned areas of responsibility.
· Works with Chief Operating Officer in development and execution of overall ambulatory managed care and revenue cycle strategies.
· Collaborates with Front Desk to establish routine evaluations and reporting to identify and implement performance improvement processes for Managed Care patient retention, patient enrollment & redetermination. Ensures new and existing patients are properly assessed and enrolled in eligible health plans, (e.g. assessing and enrolling patients into Medicaid, Managed Care, Medicare Advantage plans).
· Evaluates, and tracks trends for CountyCare members receiving care outside Cook County Network to provide actionable recommendations, identify areas for outreach and bring those members to receive ambulatory or specialty care at our ACHN and Cook County Hospitals
· Develops and executes plan in collaboration with (build team with key members: marketing, operations, etc.) to increase utilization of Cook County services for existing CountyCare members. Provide evidence-based recommendations on prioritization target populations and ACHN centers/hospitals.
· Partners with Quality team to identify, analyze, and project annual HEDIS quality incentive opportunities.
· Bachelor's degree in health care administration, community health, public health, business or other relevant area of study from an accredited college or university. (official transcripts due at time of interview)
· Five (5) years of experience within the last seven (7) years working directly with managed care organizations (MCO's) and partnering with MCO's to improve contract performance measures.
· Five (5) years of management experience (manager or higher) working in healthcare setting with direct responsibilities over front-end revenue cycle, managed care, and/or billing and collections.
· One (1) year of experience creating plans and executing system wide billing improvements to reduce reimbursement denials.
· Proven track-record creating implementation plans to achieve/exceed managed care contract performance measures, and attaining performance incentive payments that result in increased revenue.
· Master's degree from an accredited college or university
Knowledge, Skills, Abilities and Other Characteristics
· Knowledge of Managed Care plans, managed care contracts, Centers for Medicare and Medicaid Services (CMS) HEDIS measures, front end revenue cycle operations, front-end revenue training, ambulatory operations
· Knowledge of Microsoft Office, MEDI, insurance verification software
· Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
· Excellent program development, management and leadership skills
When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service
To take advantage of this preference a Veteran must :
· Meet the minimum qualifications for the position.
· Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question,
ABOUT COOK COUNTY HEALTH (CCH)
The Cook County Health’s mission is to deliver integrated health services with dignity and respect regardless of a patient’s ability to pay; foster partnerships with other health providers and communities to enhance the health of the public; and advocate for policies that promote the physical, mental and social wellbeing of the people of Cook County.
CCH is comprised of two hospitals, John H. Stroger, Jr. Hospital and Provident Hospital, a robust network of more than a dozen community health centers, the Ruth M. Rothstein CORE Center, the Community Triage Center, the Cook County Department of Public Health, Cermak Health Services, which provides health care to individuals at the Cook County Jail and the Juvenile Temporary Detention Center, and CountyCare, a Medicaid managed care health plan.
The system cares for more than 300,000 patients each year and its physicians are experts in their fields, committed to providing their patients with comprehensive, compassionate and cutting-edge care. Today, CCH is transforming the provision of health care in Cook County by promoting community-based primary and preventive care, growing an innovative, ...collaborative health plan and enhancing the patient experience.
COOK COUNTY HEALTH IS AN EQUAL OPPORTUNITY EMPLOYER