At the direction of the VP of Strategic Pricing & Analytics: Participate in developing the strategic course for the Company in such areas as delivery system redesign, healthcare reform and strategic pricing approaches for Commercial payors; and Administer, coordinate and support all Commercial managed care negotiation, contracting and reporting activities on behalf of the HCA facilities in the respective Divisions/Markets comprising the Region, pursuant to the business/financial plan and SP&A policies and procedures.
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 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 dollars but no more than $2.5B dollars which includes hospitals, ambulatory surgery centers, various ancillary provider types and employed physicians.
- The AVP is responsible for preparing the annual Market Strategic Reviews with his/her VP for each market/division. The strategic review should include at a minimum the Division CEO and CFO. The Strategic Reviews need to be completed by July 31
of each year. The AVP will ensure that all required processes and available strategic pricing tools
- The AVP will oversee the successful coordination, negotiation and implementation of Commercial contracts with Managed Care Organizations, and to maintain effective working relationships with his/her counterparts at such MCOs.
- Following every quarter, the AVP will perform a Quarter End Pricing review for the VP. The analysis will include a comparison of actual to budget performance with explanations of any variances by health plan and between IP and OP pricing targets
- Oversee the successful coordination, negotiation and implementation of Commercial contracts with Managed Care Organizations, and to maintain effective working relationships with his/her counterparts at such MCOs. The AVP will ensure that all required processes and available strategic pricing tools 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 pricing and EBDITA bandwidth management objectives.
- The AVP will collaborate and assist with his/her SP&A-Government Payors colleagues’ contracting activities with MCOs.
- As a key member of the SP&A senior management team, participate in strategic development initiatives as assigned by the SVP, CVP or VP, including but not limited to such things as alternative payment methodologies (e.g., capitation, pay-for-performance, bundled payments, patient-centered medical homes, etc.), contracting practices (e.g., language standards, creative/protective provisions, etc.), healthcare reform (e.g., ACOs, VBP, HIX, etc.), delivery system redesign opportunities (e.g., employer engagement, collaboration with HCA Physician Services colleagues, PHO/IPA direction, etc.), subject-specific task forces, etc.
- Ensure assimilation as a key member of Group/Division/Market operations management team (e.g., Presidents, CEOs, CFOs, COOs, CNOs and Directors, including hospitals, ASCs, IDTFs and HCA Physician Services), and provide expertise, support, constituent 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 SP&A activities.
- Comply with standard Company reporting and signatory requirements, including but not limited to timely submitting Monthly Operating Report attestations and various other monthly reports (e.g., Major Payor Update, ASC Update, HCAPS 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 (as applicable), adhering to Contract Process and approving Contract Strategy Documents, evaluating and processing Alternative Payment Methodology initiatives, completion and documentation (in HealthStream or in-person attendance) of annual Code of Conduct and other required training activities, business/travel expense processes through Concur (both for self and in approving subordinates’ reimbursement requests), human resources policies and procedures relative to direct reports (e.g., use of 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, and provide copies of finalized documents to the Shared Service Center, ASD, HCAPS and other operational counterparts as may be applicable to the contract in question, on a need-to-know basis.
- 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 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, CVP, VP, Division CEO/CFO, ASD and hospital leadership.
College graduate required, Masters preferred. 7+ years of experience. Managed Care experience, specifically in the areas of financial analysis, payment methodologies, contract language and negotiations.
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