Job Abstract

Reporting to the Executive Vice President/Chief Corporate Officer, the FPI Corporate Senior Director serves as FPI’s point person for payer contracting and operational payer related issues (Federal, State and delegated) as well as managing all activities and aspects required for the organization to meet regulatory requirements for clinical quality reporting in collaboration with departmental leadership. Performs ongoing payer assessments and analyzes impact to FPI. Serves as central contact to coordinate FPI payer contracts and UMSOM clinical department business development initiatives. Established collaborative relationships with SOM clinical department leadership, and UMMS office of managed care. Participates in UMMS global managed care contracting initiatives. Serves as a content expert on all current (Meaningful Use, PQRS, Value Based Modifier, MACRA, MIPS) and future regulatory programs developed by the government. The Corporate Senior Director must utilize strong interpersonal skills to effectively interface, communicate and build relationships with the regulatory entities and commercial payers that oversee these programs. Oversees the credentialing activities for PBO groups in addition to serving as the primary contact for delegated credentialing issues for all FPI practices. Provides coverage for the Concierge Services which is a 24/7 operation catering to VIP patients as well as coordinates international consultations with the requestors and the physicians. Works with executive leadership in setting the quality vision and goals for the organization.

EDUCATION and/or EXPERIENCE

• MBA or MHA preferred or BA in related field combined with minimum ten years of managed care experience
• Minimum five years leadership experience
• Experience with payer contracting and/or credentialing preferred
• Knowledge of back and front office operations
• Knowledge and understanding of FPI contracts
• Knowledge of inpatient, critical care, emergency and/or outpatient procedures
• Current knowledge of GE or similar computerized billing system
• Knowledge of ICD-10 and CPT coding
• Strong customer service skills
• Experience with provider enrollment; inclusive of: 1. NPPES, 2. PECOS and payer credentialing processes