Director of APM, Payer and Broker Relations
Description:
Are you passionate about serving patients in an inspiring work environment alongside talented people? Get moving with OCR! With over 50 years in business, we are the premier provider of orthopedic care in Colorado, Wyoming, and Nebraska. Our organization continues to grow and we are looking for individuals who share our mission.
The Director of Alternative Payment Models (APMs), Payer and Broker Relationships is responsible for the successful development and growth of the APM portfolio at OCR and maintenance and optimization of existing fee for service contracts. This position works closely with the executive leadership of OCR in establishment of the APM portfolio.
Essential Duties and Responsibilities
The mission of the Alternative Payment Models (APM) and Payer and Broker relations director will be accomplished by (1) development of a data gathering and analytics process (2) creation of an APM portfolio (3) development and maintenance of relationships with internal and external stakeholders and (4) maintenance of fee for services contracts.
The APM and payer and broker relations director will establish a written vision for the department. The vision will be updated yearly, shared with leadership and the director’s team, and used to guide the strategic objections and decision making of the department.
Key Results Area #1: Data Gathering and Analytics
- Design a data analytics process and system to provide data-driven insights to recommend opportunities to leadership in line with the strategic objections of OCR, to optimize current fee for service contracts and development of an APM portfolio.
- Ensure analytics are actionable and aligned with organizational strategic priorities, needs, plans and resources.
- Produce regular and accurate case costs and profits for all cases performed in OCR surgery centers, recommending charge increases to leadership as necessary to maintain profit margins.
- Creation of analytics and reporting solutions to support lower per capita health care costs, improved outcomes and quality of care received, and optimal patient and provider experiences with care delivery.
- Development of qualitative and quantitative analysis of APM performance data to ensure APMs are financially profitable and provide regular and concise updates of APM operational status, key metrics and profitability to CEO, CFO, COO and physicians.
Key Results area #2: Creation and Maintenance of APM Portfolio
- Utilize data analytics to identify and inform APM portfolio strategy development in conjunction with the CEO and CFO.
- Partner with necessary internal and external stakeholders to execute clinical and business strategies to drive the development of an effective and profitable APM portfolio.
- Lead implementation and execution programs for APM onboarding, APM committee development as needed and support operations a needed.
- Work closely with clinical leadership and COO to actively monitor APMs developed, working in collaboration to make necessary changes to maximize profitability of APM.
- Provide subject matter expertise in the Medicare Shared Savings Program, Medicare Advantage and other emerging Medicare APMs, Commercial APMs, Medicaid APMs and Episodic Based APMs
- Engage with marketing to communicate APM portfolio development and performance to community stakeholders.
Key Results Area #3: Relationship development
- Serves as a strategic business partner to internal and external stakeholders as demonstrated by providing thought leadership and subject matter expertise, and by anticipating and actively proposing, designing and executing analyses.
- Accountable for establishing strong, collaborative relationships and regular communication with existing and new payers, brokers, TPAs and HR directors of large self-funded health insurance plans focused on Northern CO, Wyoming and Western Nebraska.
- Provide consultative, technical, subject matter and business expertise mentorship to colleagues across the company.
- Develop close working relationships with OCR leadership to promote successful development of programs through influencing and promoting collaboration.
Key Results Area #4: Maintenance of Fee for Service Contracts
- Responsible for managing portfolio of existing Fee for Service (FFS) contracts with third party payers and other contracting agencies.
- Investigate and recommend new payer relationships, developing FFS payer proposals including pricing, customer needs assessment, and procedural and operational systems.
- Perform a yearly rate review of all fee for service payer contracts,
- Identifying carve outs needed (i.e. implants, multiple procedures etc.)
- Negotiate rate increases as reasonable
- Making sure legal language is consistent with OCR and related entities policies
- Research payer premium designation programs, determine criteria for rankings and monitor physician participation, reporting discrepancies to CFO.
- Work with Colorado State University Department of Athletics on payer agreement related issues.
- Monitor and audit the contractual compliance of claims payments, identifying and correcting any fee schedule errors or misinterpretations.
Other
- Maintain a working knowledge of applicable Federal, State and local laws/regulations, OCR policies to ensure adherence in a manner that reflect honest, ethical and professional behavior.
- Keep up to date on market trends and research.
- Growth and development of a team as needed.
- Maintain and execute a personal growth plan attending meetings, seminars and/or conferences as needed to maintain a current understanding of the industry.
Requirements
- Bachelor’s degree is required.
- Five or more years’ experience in the insurance or medical industry or equivalent experience in a business/accounting department with management experience required. Additional education may be substituted for experience.
- Core competencies in relationship management, strategic thinking, data analytics, leadership, business acumen, planning/organizing, communication, and confidentiality
- Acceptable motor vehicle driving history, valid and free from restrictions, and must have appropriate vehicle insurance coverage. Ability to travel between all OCR locations.
Core Competencies
- Relationship Management: Excellent emotional intelligence and people skills. Demonstrated ability to build long-term, high-trust relationships with internal and external stakeholders, strategic partners and vendors.
- Strategic Thinking – Develops strategies to achieve organizational goals; understands organization’s strengths & weaknesses; analyzes market and competition; identifies external threats and opportunities; adapts strategy to changing conditions.
- Data analytics: abilities to identify and collect data required, manipulate data transforming and cleaning the data as needed, demonstrate ability to deal with anomalies in data and data interpretation.
- Leadership – Exhibits confidence in self and others; inspires and motivates others to perform well; effectively influences actions and opinions of others; accepts feedback from others; gives appropriate recognition to others.
- Business Acumen – Understands business implications of decisions; displays orientation to profitability; demonstrates knowledge of market and competition; aligns work with strategic goals.
- Planning/Organizing – Prioritizes and plans work activities; uses time efficiently; plans for additional resources; sets goals and objectives; organizes or schedules other people and their tasks; develops realistic action plans.
- Oral and Written Communication – Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; writes clearly and informatively; Edits work for spelling and grammar; Able to read and interpret written information. Ability to communicate with clients or customers.
- Confidentiality – Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy. Adheres to HIPAA guidelines.
Supervisory Expectations
Directly supervises one or more employees. Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Physical Requirements
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
(The phrases “occasionally”, “regularly”, and “frequently” correspond to the following definitions: “occasionally” means up to one-third of working time, “regularly” means between one-third and two-thirds of working time, and “frequently” means two-thirds and more of working time.)
- The work environment is the typical office environment. The employee must be able to complete their work satisfactorily in an environment where there are significant distractions, including staff, patients, and vendors walking through and conversing, telephones ringing, conversations carrying over, loud noises, and interruptions to answer questions from others.
- While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle, or feel objects, tools, or controls up to 8 hours per day. The employee frequently is required to talk or hear. The employee is occasionally required to stand; walk; reach with hands and arms, and stoop, kneel, crouch, or crawl.
- The employee may occasionally lift and/or move up to 25 pounds and should do so in a sound and safe manner. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
Benefits:
- Medical, Dental, Vision coverage
- Life and AD&D Insurance
- Short Term and Long Term Disability Insurance
- Retirement savings and profit sharing plan participation
- Employee Assistance Program
- Continuing Medical Education (depending on position)
- Paid Time Off
*Benefit eligibility is dependent on employment status, and a waiting period may apply.
Orthopaedic & Spine Center of the Rockies (OCR) is an Equal Opportunity Employer and prohibits discrimination or harassment of any kind. OCR is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions are based on business needs, job requirements and individual experience and qualifications, without regard to a person’s race, color, age, sex, gender identity, gender expression, marital status, sexual orientation, religion, creed, national origin, the presence of any physical or mental disability, or status as a disabled veteran, recently separated veteran, other protected veteran, or Armed Forces service medal veteran, or any other protected status.
Posting Information
Posting Date:
June 29, 2023
Location:
Fort Collins
Department:
Finance
Job Information
Pay Rate:
$130,000 - $190,000/per year, commensurate with experience
