Practice Development Director

Title:                       Practice Development Director (PDD) Job Summary:       The Practice Development Director acts as the primary contact and resource for the company’s Mergers and Acquisitions team.  The position is responsible for the tasks to initiate and finalize the merger or acquisition process of each provider. Job Duties:
  1. Effectively supervise provider relations staff/department to ensure that organizational goals are met.  Provide direction and develop staff in accordance with company standards. Oversee and supervise staff in contract preparation to ensure accuracy.
  2. Create effective communication strategies; conveying clear messages, identifying appropriate message content and delivery, listening actively, and developing clear written communications.
  3. Communicate with confidence difficult messages that support company decisions while maintaining credibility with providers.  Keeps management aware of provider concerns and problems of an extremely sensitive and highly confidential nature.
  4. Provide timely follow-up of leads received by the company.
  5. Meet with provider leads at their convenience at a place of their choosing to further discuss their plans, timeline, and situation.  Deliver information about the company and explain the process should the provider decide to become part of Omni Family Health.  Answer any questions they may have.
  6. Prepare and deliver initial confidentiality and Business Associate Agreements for provider’s signature.
  7. Prepare and forward Medical Services, Transition, Asset Purchase Agreements and any other agreement required to complete the merger or acquisition.
  8. Distribute executed agreements internally and externally in accordance with company’s Policies and Procedures.
  9. Request from providers information needed by the company to perform its Due Diligence related to the financial state and performance of the provider’s practice.
  10. Prepare ‘needs’ reports utilizing HRSA’s UDS Mapper online tool.
  11. Track progress of all providers going through the merger or acquisition process.  Share information with key staff.
  12. Keep accurate files for each provider going through the merger or acquisition process.
  13. Prepare summary of each provider’s information for posting on SharePoint.
  14. Keep COO apprised of progress and of any challenges or issues in the merger and acquisition of any provider.
  15. Direct and integrate the Provider Relations areas in an efficient manner to facilitate a smooth workflow.  Encourage an open environment in working with all other departments of the management company.
  16. Work collaboratively with company’s counsel as directed by the COO.
  17. Oversee provider satisfaction survey including collection of data, compilation and summarization of results.
  18. Perform other duties as directed by the COO.  The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position.  Employees may be directed to perform job-related tasks other than those specifically presented in this description.
  19. Participate in the analysis of managed care proposals and in developing negotiation strategy for financial terms with payers.  Also, participates in the portion of execution of managed care contracts related to reviewing contract language with pertinent staff and legal counsel.  Coordinate the contract language review/edit process and negotiates modifications or terms as necessary.
  20. Develop communication and communicate with appropriate personnel regarding new contracts and any modifications or renewal of contract terms.  Support operational staff in contract terms issue resolution with the payers.
  21. Assist in maintaining contract database for tracking and managing contract cycle.  Distributes information internally relating to provider changes, adds, terminations, etc. in conjunction with Provider Operations.
  22. Negotiate single case agreements with non-contracted payers for specific individual patient services to be provided by the health system and its affiliated providers.
  23. Implement department policies and procedures to manage all managed care agreements.  Specific experience in contract language negotiation and managed care contracting statutes.  Identify annual contract renewal dates and proactively begin the process of language and rate review.  Represent the health center at all payer meetings to discuss medical management and budget outcomes, involving all other hospital and subsidiary staff as needed.
  24. Responsible for working with Business Office leadership in identifying and creating work plan to resolve contract interpretation issues or improve contract structure to allow for more efficient billing and claims adjudication.
  25. Work collaboratively and closely with hospital, business office and OFH leadership in defining strategies, new business opportunities, and timely completion of managed care contracts and support network needs.
  26. Responsible for maintaining schedule of all renewals for existing contracts, and managing the correspondence to the health plans regarding all issues, including but not limited, to the renewals, and to manage this correspondence in a timely manner consistent with company standards.
  27. Creates a strategic plan at the divisional level to lead in the execution of OFH agreements within the specified time frames according to department and company policies and procedures and in compliance with all pertinent regulatory requirements.
  28. Contributes to strategic divisional plans for executing OFH agreements for new physicians and physician groups.  Also, responsible for all physician contract activities from strategic planning and development with other departments through initiation of communication with the physicians to follow-through-to-signature for all parties.
  29. Ensuring entities at all levels of the organization will be informed about any and all terms of negotiated contracts and understand their role in ensuring that contracts are implemented quickly and accurately.
  30. Maintain compliance with Centers of Medicaid and Medicare services (CMS) laws and regulations, policies and guidelines regarding Medicare Advantage Plans; HIPAA privacy and security regulations; corporate compliance and conflict of interest policies.
Additional Duties:
  1. HIPAA compliance – responsible for maintaining abreast of and in compliance with all HIPAA regulations and requirements.  Treat all patient information as confidential.
  2. Compliance – Ensure compliance with all local, state and federal regulations.
  3. QNQI – Participate in QNQI activities and contribute towards the overall performance improvement of the organization.
  4. Participate in Patient Centered Health Home Model at Omni Family Health.
Qualifications: Education, Skills and Experience
  1. Two or more years of provider relations and/or customer service experience working with a medical group or IPA in a managed care environment preferred.
  2. Bachelor's Degree from an accredited college or university preferably in healthcare administration or other related field, MBA or MHA preferred.
  3. Relevant work experience and/or technical training may be substituted for academic requirements.
Essential/Required Skills
  1. Must be able to demonstrate relationship management, instill credibility and trust, and influence through collaboration.
  2. Excellent communication skills; able to read, write, and speak articulately, using established channels of communication and reporting relationships within the organization.  Ability to communicate effectively with all levels of internal/external staff, management, member's physicians/physician office staff, vendors, etc.
  3. Ability to create professional documents using proper grammar, punctuation and appropriate reading level.
  4. Strong problem-solving abilities.  Ability to identify issues and problems within administrative processes activities, and other relevant areas.
  5. Must be attentive to detail, accurate, thorough, and persistent in following through to completion of all activities, demonstrating initiative for completing work assignments.
  6. Ability to handle various situations in a professional manner, demonstrating excellent customer service at all times and ability to adapt to change.
  7. Willingness to work as part of a team, working collaboratively with others to achieve goals, solve problems, and meet established organizational objectives.
  8. Ability to effectively provide feedback to team members through written and verbal communication.
  9. Work independently, keep workload organized/prioritized and demonstrate effective follow-up and problem solving skills.
  10. Ability to read and comprehend documents of a moderately complicated nature.
  11. High degree of professionalism and knowledge of business operations.
  12. Ability to continually re-prioritize to meet the needs of internal and external customers throughout the workday.
  13. Proficient in the use of Microsoft Office applications such as; Excel, Word, Access, Outlook, PowerPoint, Project.
  14. Thorough knowledge of generally accepted professional office procedures and processes.
  15. Ability to use the following general office equipment correctly and safely: desktop computer for data entry and typing, printer/copy machine, scanner, facsimile machine, and telephone equipment.
  16. Must be able to travel to locations both in and out of town that may require overnight stays on occasion.
  17. Ability to be reliable in attendance and timeliness to work schedules.
  18. Ability to adhere to dress code, good grooming, and personal hygiene habits.
  19. Ability to maintain knowledge of and conform to company policies and procedures.
  20. Ability to maintain strict confidentiality at all times.
  21. Ability to coordinating with others that will develop and implement a managed care strategy for the health center and its subsidiaries.
  22. Will represent the health center and its subsidiaries in all managed care contract negotiations and will develop goals and objectives for the contract outcomes.  Analyze all contract language and ensure the health center's best interests are met, involving legal counsel as appropriate.
  23. Direct operations in a manner that achieves strategic initiatives, ensures legal and regulatory compliance and stewards the resources of the Health Center while providing the highest quality of service and care.
  24. Extensive conceptual and practical knowledge of HMO/PPO, FFS, capitated and specialty contracting.
  25. Maintain adequate and productive scheduling by contacting providers and/or their office personnel to schedule on-site visits.
  26. Support the mission, vision and strategic goals of OFH and the department.
  27. Attend and participate in required meetings and developmental (training) activities.
  28. Maintain all certifications or licensing required by the job.
  29. Adhere to all OFH policies and procedures as well as departmental policies and procedures.
  30. Maintain strict confidentiality at all times.  Perform duties in a manner that ensures compliance with all current laws and regulations (HIPAA, etc.).
  31. Able to adapt to new concepts, ideas and changes in work processes and the work environment.
  32. Perform all work in a safe manner and within established safety guidelines.
  33. This position involves traveling on behalf of the Company approximately two (2) to three (3) days per month.  It is essential to have access to a personal automobile.
  34. Must have a valid driver's license with an acceptable driving record and the ability to travel be able to concentrate and focus in a moderately noisy work environment.