PROGRAM MANAGER - PROVIDER CONTRACTS & COMPENSATION
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion-must guide what we do, as individuals and professionals, every day.
This position is a manager role in the Medical Group to serve as the Provider Compensation Manager for the Provider Compensation Program (PCP). The manager, with general guidance from the Director of Finance and the Director of Compensation, will oversee the day to day functions of the PCP and ensure compensation models are reconciled on a timely basis and that the day to day questions about provider compensation are resolved in a timely manner. The manager will be highly involved in the development and maintenance of fair market value (FMV) provider compensation policies, procedures, and maintenance.
- 1. Develop standardized policies and procedures for management to use when making adjustments to provider compensation (including approval level and sign off) to avoid violations of Stark Law, the Anti-Kickback Statute (AKS) and the False Claims Act (FCA).
- 2. Be prepared at all times to attend leadership meetings surrounding the provider compensation program.
- 3. Be prepared at all times to participate in leadership meetings on provider compensation
- 4. Under the general direction of the Director of Finance:
- 4.1 Manage and maintain Physician Service Agreements (PSAs) within the organization; including tracking of PSAs with expiration dates that require renewal and agreed reconciliation periods.
- 5. Under the general direction of the Director of Compensation:
- 5.1 Work closely with Physician's department leader, Human Resources and Compensation, and third-party appraisers and consultants, when necessary, to develop a standardized process for determining FMV provider compensation. Perform routine ongoing analysis to ensure that provider compensation remains aligned with FMV.
- 6. Perform other duties as assigned.
Four-year Bachelor's degree in Accounting, Finance, or related field.
requires 3 years of experience in health care or related industry with a focus on professional billing and provider compensation. Human Resource experience preferred but not required. Basic knowledge of provider compensation, including but not limited to, healthcare reimbursement, compliance, payroll, budget, data integrity, production, benchmarking and accounting.
Proficient computer skills, including use of Microsoft Office Suite products (Excel, Access) and use of data manipulation tools. Critical thinking skills with ability to identify problems and conflicts and assist with resolution. Excellent written and verbal communication skills. Ability to communicate with all levels within the organization. General knowledge of Crystal Reports. Ability to analyze problems and interpret information and to prioritize and re-prioritize, as necessary. Ability to work independently, and as part of a team.
Yale New Haven Health System, through its Yale New Haven, Bridgeport, Greenwich and Northeast Medical Group Delivery Networks, provides comprehensive, cost-effective, advanced patient care characterized by safety and clinical and service quality.
Yale New Haven Health System, in affiliation with Yale School of Medicine and other universities and colleges, educates health professionals and advances clinical care.
In all of its work, YNHHS is committed to the communities it has the privilege of serving.