CommonSpirit Health has more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services. They are committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside their hospitals and out in the community.
Responsible for ensuring that the Value Hub adheres to regulatory standards, contract requirements, and internal quality benchmarks.
Analyzing compliance data, preparing detailed reports, and working closely with various departments to maintain and improve compliance and quality standards.
Supporting the understanding of local regulatory requirements, completion of local audits, participation in quality committees, and supporting health plan needs and interactions to ensure consistent implementation of contractual obligations.
Responds to incidents and requests, performs diagnosis, troubleshooting and critical thinking.
Completes tasks and associated documentation within committed timeframes, and effectively communicating across teams.
Seeks to identify repeatable issues or requests and perform continuous process improvement activities to ultimately improve customer satisfaction experience.
Develop and implement region-level strategies for pharmacy compliance, revenue cycle, data management, technology, financial planning, and operational improvement.
Manage, improve, and develop pharmacy business and operational functions to enhance compliance, revenue cycle, data integrity, and medication-related technology implementation.
Lead, plan, direct, and coordinate business operations, fostering effective working relationships with internal and external stakeholders.
Makes decisions supported by policy based on confidential financial information.
Utilizes scheduling and registration information to verify coverage and authorization.
Acts as a liaison between the patients, physicians, patient clinics, case management, centralized billing office, third party Medicaid eligibility vendor and community agencies.
Assist with planning, directing, and implementing managed care objectives related to contract terms, reimbursement, negotiation, and key payer relationship management.
Negotiate various contract types across the organization's geographies and business lines with significant payer relationships.
Secure favorable reimbursement, protect the interests of associated entities in contract negotiations, and strengthen relationships with significant payers.