What are the responsibilities and job description for the Div Dir - PPS Operations, Quality, EOC and Group Credentialing position at Children's of Alabama?
General Summary
Responsible for operational oversight and supervision of Pediatric Practice Solutions (PPS) practices as assigned.
Responsible for managing and coordinating regulatory compliance, patient safety and performance improvement activities, group credentialing and value-based incentive programs for all PPS practices.
Essential Job Functions
50% 1. Administrative and operational oversight for PPS practices as assigned. Duties include, but are not limited to, routine meetings with physicians and managers, assisting with personnel interviews, progressive discipline, preparing physician productivity reports, analysis of financial trends (revenues, expenses, etc.), mentoring of practice leadership, and other duties as requested.
20% 2. Responsible for physician group credentialing and payer directory updates. Specific duties include but are not limited to completing credentialing forms for new groups which include Blue Cross and Blue Shield of Alabama, Alabama Medicaid, and Medicare; updating and revalidating group applications and EFT for Blue Cross and Blue Shield of Alabama, Alabama Medicaid, Medicare (PECOS), and Tricare East; updating provider directories every 90 days for Blue Cross and Blue Shield of Alabama (LexisNexis), VIVA (BetterDoctor), and Aetna and Commercial Humana (Availity); serving as a reference to practice on the individual physician credentialing process.
10% 3. Monitor and compile data from value-based incentive programs and their reimbursement, including Blue Cross Blue Shield of Alabama and Alabama Medicaid. Assure that trending is maintained and identification of needed education is identified and developed.
10% 4. Participate and represent PPS on various committees including the Environment of Care (EOC) Emergency Management Committee, EOC Safety, Security, and Work Place Violence Subcommittee, and EOC Life/Fire Safety Committee; United Way Committee. Coordinate ECRI reporting, contracted services reviews at the PPS division level.
5% 5. Identify, initiate, and facilitate performance improvement activities at the PPS division level and represent practices in the COA performance improvement program.
5% 6. Coordinate delivery of corporate services from the COA to individual practices and other duties as assigned or requested.
Education
- Bachelors’ degree, plus five (5) years experience in physician practice management required. Additional experience may substitute for education on a year-for-year basis.
- Masters preferred, MSHA/MBA or comparable degree
Experience
- Thorough knowledge and confidence in all aspects of practice operations and management
- Thorough knowledge of budget development and administration
- General management and financial/ data analysis skills and knowledge
- Knowledge of general financial analysis, key ratios, accounting principles, etc.
- Experience with regulatory compliance and process improvement activities
- Strong oral and written communication skills, as well as facilitation and presentation skills
- Strong mentoring and coaching skills
- Experience in conducting educational sessions
- Understanding of management principles to recognize and evaluate the materiality and significance of deviations from good business practice
- Computer skills (standard software) required. Proficient in spreadsheet analysis and knowledgeable in a variety of software applications, i.e., various practice management systems and electronic health records, Microsoft Office applications, and other software utilized by PPS practices as appropriate
- Knowledge of Children’s of Alabama and its various departments is a plus
Physical Requirements/Working Conditions
- Must be able to lift up to 30 pounds.
- Must be able to bend, stoop, and stand without restrictions.
- Must have full use of arms and hands with full range of motion.
- Must be able to read and comprehend numerical and alphabetical filing system.
- Ability to operate vehicle and travel to all PPS facilities. Must provide proof of current Alabama Driver's License and automobile insurance with minimum coverage as required by COA policy.
