Do you have the career opportunities as a AVP Dispute Resolution you want in your current role? We have an exciting opportunity for you to join Parallon, a team that is part of the nation's leading provider of healthcare services, HCA Healthcare.
At Parallon, we offer an array of medical, dental, and vision packages as well as several add-on perks to make your benefits package truly customizable to you and your family needs. Some of our unique benefits we offer include:
- Tuition Reimbursement/Assistance Programs/Student Loan Repayment
- Paid Personal Leave
- 401k (100% annual match – 3%-9% of pay based on years of service)
- Identity Theft Protection discounts
- Auto, Home, and Life Insurance options
- Adoption Assistance
- Employee Stock Purchase Program (ESPP)
You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated AVP Dispute Resolution like you to be a part of our team.Job Summary The AVP, Dispute Resolution is responsible for the Legal Escalation Unit operations and performance, including all start-up activities. This specialized unit will focus on overturning denial write offs for all major managed care payers and underpayment disputes. The AVP will have oversight of a dedicated team consisting of legal counsel and supporting analyst resources. This individual will have critical responsibility for start-up process design and integration of new and existing technologies into operations. Building a strong communication network and serving as a primary point of contact with the SSCs, payers, corporate departments, etc. will be required. Duties (included but not limited to):
- Responsible for developing and maintaining high quality processes in order to maximize net revenue through legal escalation of denial write offs and underpayments.
- Responsible for managing a legal counsel team and supporting resources that will focus on overturning major payer denials and underpayment disputes.
- Responsible for working with collections and payment compliance departments to escalate final denial write- offs and underpayments via a pre-litigation or litigation process.
- Leverage new and existing technology capabilities accordingly and integrate into operational processes.
- Manage transition and business continuity of processes between the Legal Escalation Team, the SSCs and other stakeholders; engage other corporate support departments such as Education, Project Management, HR, SMEs etc. accordingly.
- Interview, hire and provide overall supervision to the Legal Escalation Team and associated departmental employees. Responsible for acceptable competency levels of all staff.
- Develop appropriate quality and productivity metrics for each area of responsibility.
- Motivate the Legal Escalation Team through continual feedback and recognition.
- Champion change management programs, with strong focus on effective and timely communication to the Legal Escalation Team, SSCs, HCA corporate departments, PCA, payers and other stakeholders.
- Responsible for achieving outlined overturned rates.
- Engage with specific payers and champion the joint identification of improvement opportunities such as new process design, technology leverage, and organizational modifications.
- Support SSC leadership to ensure they have timely, adequate information regarding targeted payers for communication to Division, Market and Hospital customers.
- Provide strong and stable leadership by creating an environment that is positive, motivating and promotes accountability and results.
- Monitor and ensure adherence to specific objectives, budgets, and performance standards for each area of responsibility.
- Provide daily management and oversight to ensure processes occur accurately and timely within assigned areas and hold personnel accountable for driving results.
- Monitor key indicators and escalate when appropriate.
- Monitor cash flow to ensure achievement of SSC goals.
- Ensure compliance with company policies and procedures to minimize process variation and maximize results.
- Supervise the preparation and maintenance of departmental policy and procedure manuals in compliance with BPG standards.
- Establish specific controls to ensure operational compliance.
- Prepare and/or analyze weekly and monthly reports and assist with communications to SSCs, corporate departments, payers, etc.
- Comply with all reimbursement and billing procedures for regulatory, third party and private insurance payers.
- Establish and maintain effective internal controls to ensure all SOX and audit guidelines are achieved.
- Provide feedback to Parallon SME's regarding process improvement opportunities.
- Perform staff reviews and prepare performance documents for direct reports.
- Bachelor's Degree in Business or related field
- Minimum 10 years' experience in a similar position within a hospital or related field is required
- Multi-facility experience preferred
Parallon believes that organizations that continuously learn and improve will thrive. That's why after more than a decade we remain 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.
We are a wholly owned subsidiary of HCA Healthcare, a comprehensive healthcare network where over 265,000 people across more than 1,800 care facilities are all committed to creating a positive impact every day. It's an organization that exists to give people healthier tomorrows. HCA Healthcare has been continually named a World's Most Ethical Company by Ethisphere since 2010. In 2018, HCA Healthcare spent an estimated $3.3 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
If you find this opportunity compelling, we encourage you to apply for our AVP Dispute Resolution opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. We are actively interviewing so apply today!
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.This position is incentive eligible.
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