What are the responsibilities and job description for the Payor Operations Manager position at Proactive MD?
People are a company's greatest resource, which is why caring for employees and keeping them healthy is so important. Proactive MD offers a comprehensive health management solution that extends well beyond the clinic walls. Access to on-site physicians, full direct primary care services, and excellent client support are the hallmarks of our program. By engaging a workforce and offering them a personal relationship with a primary care physician, we can deliver measurably better outcomes, making people happier, healthier, and more productive while significantly lowering overall medical costs for employers. We put employees' health first because amazing care yields amazing results. We are the next generation of workplace health centers.
JOB SUMMARY
The Payor Operations Manager leads the Health Center Operations team for multiple locations while ensuring strong relationships and collaboration with Population Health, Medical Affairs, Implementations, Patient Experience and Service Delivery. They will use critical thinking, knowledge of clinical policies and procedures, workflows, processes, and systems to support efficient and safe health center operations while ensuring our patient promise is delivered according to regulatory and quality standards. They will work closely with the Director of Payor Operations with a shared goal of exceptional the Health Center financials, clinical performance, and client relationships.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Maintain effective communication and build good working relationships with care teams, leadership, and other stakeholders
Ensure Organizational policies and procedures, standard workflows, and processes are implemented in assigned health centers
Ensure regulatory standards and contract obligations are met
Ensure appropriate and accurate internal and external data capture
Oversee and manage Health Center P & L with emphasis on revenue side and escalation to Director of Payor Operations on any significant revenue shifts
Surveil coding and billing processes to ensure care teams are meeting payor requirements
Manage and resolve all patient escalations in reasonable timeframe and provide appropriate follow up with staff including training, education, coaching, and/or process improvement to prevent reoccurrence of same escalation.
Make scheduled site visits to each of the assigned health centers
Schedule and complete one staff meeting monthly with each assigned health center to review patient satisfaction survey results, audit scores, policy reviews, established KPIs and discuss any staff concerns.
Complete employee performance reviews on time for all direct reports and provide progressive discipline/performance improvement when necessary
Ensure appropriate staffing of all health centers and interview and onboard all new team members
Collaborate effectively with Service Delivery Team to ensure Client and Health Center needs are met including equipment, supplies, staffing, and formularies and manage procurement requests outside of standard formularies
Ensure best scheduling practices are being followed to meet the needs of each health center, and that all health centers are compliant with policy and procedures
Attendance at trainings, department and interdepartmental meetings
Evaluates and manages all clinical processes in health centers for excellence and efficiency, including EMR, Patient Portal, laboratory, dispensing, and supplies/equipment to identify areas of opportunity for improvement.
Ensure compliance with audit standards and any follow up items are resolved PRIOR to re-audit
Collaborate with Implementation Team to establish new health centers, as assigned
Supports implementation or integration of new services or products within assigned health centers
KNOWLEDGE, SKILLS, & ABILITIES
Required:
• Registered Nurse, BSN
• Prior management experience in healthcare setting of clinical teams
• Strong clinical background with developed critical thinking skills
• Knowledge of payors and value-based care arrangements
Preferred:
• Outpatient or Primary care experience
WORK ENVIRONMENT & PHYSICAL REQUIREMENTS
This job primarily operates in a professional office environment. The following physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job:
While performing the duties of this role, the employee is regularly required to talk, see, and hear.
Prolonged periods of sitting at a desk and extended use of a computer are required.
The employee frequently is required to stand, walk, use hands, reach with hands and arms, and occasionally lift office products.
Additionally, the employee will need to be able to lift/move/store individual 20-30 pound boxes and items such as office and medical supplies and equipment.
POSITION TYPE & EXPECTED HOURS OF WORK
This role will be expected to work a minimum of 40 hours/week as directed. Typical workdays are Monday through Friday, 8:00am to 5:00pm. This role is considered an exempt position. Evening and weekend work are infrequent but may occasionally be required as business needs dictate.
TRAVEL
Travel to clinics is required for up to 80% of this role, either in state or out of state as demands of the company dictate.
OTHER DUTIES
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
