Manager, HOPD Practice Operations

Inspire health. Serve with compassion. Be the difference.

Job Summary

Manages the business administration of the Medical Group in support to the Prisma Health mission and goals. Develops internal departmental resources, utilizes Admin support, and accesses Prisma Health corporate services as appropriate to maintain accountability for areas outlined below.

Essential Functions

All team members are expected to be knowledgeable and compliant with Prisma Health's values : Inspire health. Serve with compassion. Be the difference.

Develops, monitors, and manages annual fiscal budgets. Prepares ad hoc financial reports. Responsible for the intra-departmental control of corporate assets and the effective / efficient management / utilization of clinical department resources. Facilitates responsible decision making to balance fiscal and academic missions. Coordinates and establishes the annual capital budget in accordance with equipment needs and the department's business plan.

Liaison between clinical department and University Medical Group Leadership and responsible for accurately conveying related communications to physician faculty and staff in a timely manner. Responsible for communicating corporate goals, decisions, and operating guidelines to service line staff. Participates in the development and implementation of the annual marketing plan in coordination with the system's strategic direction. Ensures that all internal and external communication material appropriately reflects the mission and values of Prisma Health. Actively engaged in providing regular flow of clinical department information to formal communication plan effort.

Recruits and selects appropriate staff within the constraints of approved budgets. Trains employees on policies and procedures of department and Prisma Health. Evaluates and monitors work performance of designated staff. Counsels, disciplines, and terminates designated staff as necessary. Establishes productivity standards for support staff and monitors their adherence. Ensures the establishment of employees' annual performance goals. Prepares and conducts timely and appropriate performance appraisals. Ensures that all positions have accurate, valid position descriptions on file and that employees are familiar with the position description and the standards of performance. Ensures that the program operates in an environment where all employees are treated fairly and in accordance with policies and procedures.

Measures and understands reimbursement by payer, by procedure code, for services rendered by the department. Measures and understands physician clinical productivity levels rendered against national norms by provider. Measures and understands appropriate staffing levels for services provided against national practice management benchmarks (ACMPE, MGMA, AAMC). Measures financial performance of clinical department via regular review of and formal comment upon monthly departmental income statements as well as other financial reports as deemed appropriate.

Participates in review of terms, plan requirements, and reimbursement rates of potential managed care contracts. Effectively utilizes Legal and Contracting Department in negotiation of all non-insurance related contracts, i.e., lease agreements, equipment purchase / rental, external consulting services, etc.

Directs the daily business and clinical functions of the practice while serving in a leadership role for the clinical department to ensure its smooth operation within the strategic plan and mission statement in coordination with the Director, Medical Group Operations and the Administrator. Efficiently manages billing processes "front office functions", within parameters established by regulations (i.e., including charge capture, coding, documentation, claims processing, demand billing, payment posting). Works with Reimbursement Department to review diagnosis and procedure codes utilized by the department to ensure greatest reimbursement while maintaining compliance with regulatory guidelines. Works with Reimbursement Department to maintain knowledge and expertise in billing related matters associated with department specialty and communicate pertinent information to staff and physicians. Responsible for all clinical department practice management functions including charge capture compliance, pre-certification and other effective billing practices. Registration, insurance verification, reimbursement and, collections. Monitors the registration process to ensure efficient patient access and flow to and from practice. Ensures the resolution of third-party reimbursement issues by working with Administration, Reimbursement and Managed Care Departments' staff respectively to maximize reimbursement within the limits defined by law. Maintains a working knowledge of third-party payment practices, including (as applicable) Medicare, Medicaid, managed care organizations, private insurers, worker's compensation carriers and occupational medicine payment practices. Works with managed care department to assist their contract negotiations with third party payers and managed care organizations. Analyzes the financial impact of managed care contracts for clinical department. Participates in the recruitment and selection of physician personnel. Ensures payroll is prepared and submitted in accurate and timely manner. Ensures compliance by all employees with time and attendance guidelines. Analyzes data to project staffing needs and ensure adequate staff coverage in all areas. Initiates, develops, implements, and maintains clinical department practice management procedures to ensure operational effectiveness and compliance with policies and procedures and the system's Code of Excellence. Assists in any follow-up necessary to ensure prompt payment.

Solicits feedback on overall satisfaction from clients and referral sources through satisfaction surveys. Evaluates feedback and makes recommendation for change to address identified issues. Establishes processes to identify new or improved services to meet client needs and implements those services where appropriate. Measures quality indicators such as cost effectiveness, efficiency and outcomes data on a regular basis. Report measurements of quality indicators to staff as well as the Director, Medical Group Operations. Responsible for leading the physician practice component of JCAHO reviews for their respective clinical department practice locations. Ensures compliance with regulatory and accreditation agencies. Ensures the coordination of clinical procedural changes, new program development, standards of care and ongoing activities with the Director, Medical Group Operations.

Performs other duties as assigned.

Supervisory / Management Responsibilities

Job has direct and / or indirect supervision of employees that may include final budget authority, hire / termination / disciplinary authority, performance appraisal responsibility. Job will be considered a member of the management staff with direct reports.

Minimum Requirements

Education - Bachelor's Degree in Healthcare management, Clinical Field, Business / Finance or related field of study. Master's degree Business or Healthcare preferred

Experience - Five (5) years in physician practice management

In Lieu Of

Bachelor D. plus five (5) years of Prisma Health experience in Personnel Mgmt., Finance or Operations; OR

Bachelor D. plus three (3) years in physician practice management, personnel mgt, finance or operations; OR

Masters D plus three (3) years of a combination of Prisma Health and UMG physician practice management, personnel mgt, finance or operations; OR

HS Diploma plus ten (10) years experience in physician practice management, personnel mgt, finance or operations including three (3) years healthcare management experience.

Required Certifications / Registrations / Licenses

N / A

Knowledge, Skills and Abilities

Work Shift

Day (United States of America)

Location

Greenville Memorial Med Campus

Facility

1008 Greenville Memorial Hospital

Department

12039035 Administrative and General

Share your talent with us! Our vision is simple : to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.