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HCA, a Fortune 100 company with more than 200,000 employees, is one of the nation's leading providers of healthcare services, operating over 170 locally managed hospitals and over 100 freestanding surgery centers in 20 states and the United Kingdom. With its founding in 1968, HCA created a new model for hospital care in the United States, using combined resources to strengthen hospitals, deliver patient-focused care and improve the practice of medicine. HCA is a learning healthcare system that uses more than 27 million annual patient encounters to advance science, improve patient care and save lives. HCA has been named one of the world's most ethical companies for eight years in a row. At HCA, we are driven by a single goal: the care and improvement of human life.
HCA's Payer Contracting and Alignment Team leads the strategic course for the Company in such areas as delivery system redesign, healthcare reform and strategic pricing approaches for Commercial payors; and administers, coordinates and supports all Commercial managed care negotiations, contracting and reporting activities on behalf of the HCA facilities in the respective markets comprising the Division, pursuant to the business/financial plan and SP&A policies and procedures.
At the direction of the RVP, Payer Contracting and Alignment: Participate in developing and execution of the strategic course for the Company in such areas as delivery system redesign, healthcare reform and strategic pricing approaches for Commercial payors (including Health Insurance Exchange QHPs); and administer, coordinate and support all Commercial managed care negotiation, contracting and reporting activities on behalf of the HCA facilities in the respective markets comprising the Division, pursuant to the business/financial plan and PCA policies and procedures. Note: This is a senior level position within the Company, with significant revenue responsibilities and requiring a high-level understanding of healthcare financing and delivery and the ability to think strategically and offer innovative solutions to the complex challenges facing both the Company specifically and the healthcare industry in general (in addition to the ability to successfully manage day-to-day operational responsibilities).
The PCA AVP will office in the Central and West Texas Division with responsibility for the Austin and El Paso markets.
The primary responsibility of the AVP is to optimize the fee-for-service price/volume equation of a Commercial net revenue portfolio greater than $1.0B but no more than $2.5B, and which includes hospitals, behavioral health facilities, provider-based (free-standing) emergency departments, ambulatory surgery centers and various ancillary provider types, and also having significant connectivity with the Company’s employed physicians (PSG) and physician alignment vehicles.
The AVP is responsible for assisting in the preparation of the annual Market Strategic Reviews and PCA budget packet with his/her RVP for each market. The audience should include at a minimum the SP&A CVP, Division CEO and Division CFO.
The AVP will oversee the successful coordination, negotiation and implementation of Commercial contracts with Managed Care Organizations (MCOs) and other Commercial Payors, and to maintain effective working relationships with his/her counterparts at such entities.
The AVP will ensure that all required processes and available strategic pricing, legal, reporting and communication tools and processes will be deployed in order to both (a) maximize contract performance/yield (e.g., Net Revenue, Percentage of Charge Revenue, Net Revenue per Adjusted Admission, Contribution Margin, etc.), and (b) be consistent with the Division’s EBIDTA and pricing bandwidth management objectives. Among these requirements will be maintaining an effective working relationship with the Analytics & Pricing Services (A&PS) and PCA Legal department staffs and adeptness with Qlikview and Service Line tools.
The AVP will collaborate and assist with his/her PCA-Government Payors and PCA-Physician Services Group (PSG) colleagues’ contracting activities with MCOs and other payors.
The AVP will be heavily involved in denial management activities, from avoidance (by securing robust contract protections) to information gathering (via regular meetings with Case Management and SSCs, maintenance of Denial Activity Tracker form and participation in DMAT) to resolution (via JOCs and other problem-solving interfacing with the MCOs) to disputes (via involvement with PCA Legal, SSC Legal and other dispute resolution processes).
Supervise, oversee and develop direct reports (if any/as applicable) in accordance with their job descriptions, all Company requirements and the dictates of personnel management best practices.
As a key member of the PCA senior management team, participate in strategic development initiatives as assigned by the RVP, including but not limited to such things as alternative payment methodologies (APMs, e.g., capitation, pay-for-performance (P4P), bundled payments, patient-centered medical homes, etc.), contracting practices (e.g., language standards, protective provisions, etc.), healthcare reform (e.g., CIN, ACO, VBP, HIX, BPCI, CJR, Population Health-based analytics, etc.), delivery system redesign opportunities (e.g., employer engagement and/or direct contracting, collaboration with PSG colleagues, assistance with physician alignment vehicle, etc.), subject-specific task forces, etc.
Ensure assimilation as a key member of HCA’s Group/Division/Market/Facility operations management team (e.g., Presidents, CEOs, CFOs, COOs, Development and Service Line VPs, CNOs and Directors, including hospitals, ASCs, IDTFs and PSG), and provide expertise, support, consumer advocacy, education, involvement in legislative issues, budgeting tools and other communication strategies to ensure a commonality of understanding, purpose and direction in all market-based PCA activities.
Comply with standard Company reporting and signatory requirements, including but not limited to timely submitting Monthly Operating Report (MOR) attestations and various other monthly reports (e.g., Major Payor Update, ASC Update, Completed Contracts Report, Behavioral Health Update, HIX/Narrow-Network Update, etc.), overseeing preparation and conduct of annual Strategic Market Reviews and Contract Strategy Presentations (CSPs), adhering to Contract Process and related PCALink, Team Room and C-Trax requirements, evaluating and processing Alternative Payment Methodology initiatives, completion and documentation (in HealthStream or in-person attendance) of annual Code of Conduct, Physician Relationship, Information Protection and other required training activities, business/travel expense processes through Concur, human resources policies and procedures (e.g., use of TMS/Authoria system for goal-setting, performance evaluations, etc.), and so on.
Ensure that a permanent record of all negotiations and documentation relating to Commercial MCO contracting activities is maintained in local files, electronic files, PCALink and/or C-Trax (or as may otherwise be permitted/required); provide copies of finalized documents to the SSC and (as applicable) Ambulatory Surgery Division (ASD) and PSG; and provide in-servicing and other summary documents to PSG, SSC and Case Management colleagues, on a need-to-know basis, in order to enable them to better operationalize such MCO contracts.
Maintain current knowledge of State and Federal regulations, laws and legislative agendas regarding the healthcare industry, paying particular attention to those that involve healthcare reform, managed care, ERISA and health insurance.
Practice and adhere to HCA’s mission and values statement and code of conduct, and attend all required ethics and compliance training and retraining.
Perform other duties as may be assigned or requested by the SVP, RVP, Division CEO, Division CFO, ASD and hospital leadership.
Managed Care experience, specifically in the areas of financial analysis, payment methodologies, contract language and negotiations. The candidate must be fluent in such systems as Word (including editing documents via redline features), Excel, Pivot Point tables and PowerPoint presentations, etc.