MANAGER, REGULATORY AND INCENTIVE PROGRAMS - Full Time - Days

Job Description

The Manager, Regulatory and Incentive Programs shall be responsible for the management of The Christ Hospital Physicians (TCHP) alignment and compliance with payor incentive program strategies. As we transition from fee-for-service to payment on value it will be critically important to monitor and strategically respond to our external stakeholders.

The Manager will continuously monitor federal, state and payor programs and serve as a key strategic advisor to the VP, Executive Medical Director and TCHP Leadership. The Manager will be an expert resource for the following programs::

• Merit Based Incentive Payment System (MIPS),

• Meaningful Use (MU)/ACI,

• Physician Quality Reporting System (PQRS)

• Comprehensive Primary Care Initiative (CPCi/CPC+)

• Patient Center Medical Home (PCMH)

• Incentive-based contracts, regulatory program audits, and other regulatory programs

The Manager will be responsible for working collaboratively to build a reporting and audit structure across all service lines within TCHP. The Manager performs as TCHP's subject matter expert for all regulatory programs and initiatives and informs the leadership team and stakeholders of regulatory changes in a timely fashion as program guidelines are modified by various regulatory agencies.

The Manager will also work with the VP, Executive Director and Leadership team to develop an ongoing relationship with Finance, Payor Relations and the Clinically Integrated Network leadership that helps to inform and identify opportunities for future payment/contracting strategies that align payor and internal capability to improve patient value through shared goals and programs.

Responsibilities

Management of Regulatory and Contract Implementation

• Plan and direct key regulatory, contractual and recognition programs appropriate to the intended use and target governing body;
• Responsible for implementing strategy and addressing opportunities related to the regulatory and data governance issues that have financial and reputational impact;
• Develop and manage the strategic opportunities and requirements that maximize incentives gained by TCHP while minimizing or avoiding penalties;
• Provide planning and oversight to TCHHN regarding regulatory, contractual and recognition program requirements;
• Manage initial and ongoing assessments of regulatory, contractual and recognition program readiness;
• Develop, evaluate and implement system changes as appropriate for new or revised regulatory, contractual or recognition program requirements;
• Identify and manage revenue opportunities presented by regulatory, contractual and recognition programs;
• Liaise with the directors of Practice Transformation, Operations, Care Management and Payer Relations to provide cross-functional guidance for regulatory, contractual and recognition program compliance;
• Collaborate with Vice President of Compliance and General Counsel of TCHHN on regulatory reporting requirements for the ambulatory service lines;
• Manage relationships with various external parties including the Greater Cincinnati Health Collaborative and other health systems to ensure TCHHN develops and leads best practices for regulatory, contractual and recognition program adherence;
• Develop and present briefings on regulatory, contractual and recognition programs to the TCHHN executive administration;
• Manage special projects as needed.

Manage Revenue Projections and Reconciliation

• Mange the Comprehensive Primary Care Plus (CPC+) revenue and expense recognition and reconciliation process for the program for TCHP;
• Collaborate with the TCHHN Finance department to create and manage a financial reporting structure that is compliant with Medicare requirements for CPC+;
• Develop and manage the revenue reconciliation and revenue recognition process for incentive and shared savings contracts with both public and private payers;
• Manage project oversight and provide guidance to IT, Data Governance and Decision Support resources to develop analytic tools and reports for respective department leaders to meet identified business needs;
• Manage the data collection and processes including reference data, between the EPIC Medical Record system, external departments/systems, and work collaboratively to develop reports as needed;
• Collaborates with payer relations and the insurance carriers to gather and process data related to contract compliance;
• Manage data analyst team to analyze internal data, industry standards and best practices and department contractual requirements to implement TCHP strategic initiatives;
• Establish and manage a detailed library of procedures and definitions required to generate consistent routine and ad hoc reports. Develops a record of the best contacts for the production of routine and ad hoc reports.

Regulatory/Program Data Submission

• Manage the process for efficient and accurate submission of publically reported measures;
• Ensures that TCHHN executes timely submissions and delivers on-time approvals with appropriate governing agencies;
• Develop and manage transparent reporting mechanisms to clearly communicate information regarding regulatory, contractual and recognition program submissions;
• Collaborate with TCHHN Compliance and General Counsel to lead the submission of required information to external parties;
• Create and implement a records retention policy that ensures all required records are maintained.

Qualifications

KNOWLEDGE AND SKILLS:

Please describe any specialized knowledge or skills, which are REQUIRED to perform the position duties. Do not personalize the job description, credentials, or knowledge and skills based on the current associate. List any special education required for this position.

EDUCATION: Masters Degree in a related field, health care management, or business management. Juris Doctor (JD) preferred.

YEARS OF EXPERIENCE: Must have a minimum of 10 years of regulatory compliance experience including 5 years health care regulatory experience, in an ambulatory physician setting with relevant progressive experience in contracting, compliance and health care quality programs.

REQUIRED SKILLS AND KNOWLEDGE: Demonstrated experience in successful submission of CMS and NCQA recognition program applications. Strong communication skills, both written and oral, to enable effective relationships with internal departments and external organizations including CMS, NCQA, the Health Collaborative and payers. Knowledge and application of a wide variety of data analysis tools and methods. Ability to operate PC based software programs including Microsoft Office, including Word, Excel, Powerpoint and Outlook. Strong problem-solving and time management skills. Ability to multi-task in a fast-paced environment and work with a variety of disciplines and levels of staff across departments. Must present professional demeanor, be a self-starter and function as a team player.

OTHER REQUIREMENTS:

Creative Individual with strong analytical and problem solving skills;

Effective verbal skills to communicate complex ideas at all levels of understanding both internally and externally;

Strong Excel and PowerPoint skills;

Excellent organizational skills

LICENSES REGISTRATIONS &/or CERTIFICATIONS:

Juris Doctor (JD) preferred