Reporting to the Vice President of Managed Care and Credentialing in the Inova System Office, located in Falls Church, Virginia, the Assistant Vice President (AVP) of Managed Care Contracting will lead the team responsible for all contract negotiations with third party payer, as well as ensuring that there is efficient and effective interaction between the health system and the third party payers as it relates to claims payment, ensuring that the yield of each contract is maximized. Contracted services covered include acute care hospitals, ambulatory surgery facilities, radiology centers, urgent care centers, free-standing emergency departments, full-service outpatient sites (HealthPlexes) reference laboratories and physician practice sites. Oversee Contract Modeling, Analysis & Reporting - analytic support during all phases of managed care contracting, including the development of complex models during negotiations and the ongoing analysis and reporting of payor performance. Oversee Network Insurance Credentialing - process for credentialing practitioners, facilities and CVO clients and Medicare and Medicaid enrollment for both practitioner and group practices in accordance with the appropriate NCQA & JC standards, managed care payers to include delegation credentialing requirements/maintenance and all applicable state and federal regulations. Incumbent will develop and maintain a network of relationships with third party payors. Incumbent will establish and maintain effective relationships with Inova facility and system operational management, as well as Inova Patient Financial Services. The AVP will support the VP of Managed Care in defining on an ongoing basis how Inova will interact strategically with third party payers on all levels, fee-for service negotiation, engagement on value-based contract structures, bundled arrangement, insurer product development, etc.
About Inova Health System
Inova Health is Northern Virginia's leading nonprofit healthcare provider, employing more than 18,000 team members and serving more than 2 million individuals annually through an integrated network of hospitals, primary and specialty care practices, emergency and urgent care centers, outpatient services and destination institutes such as the Inova Heart and Vascular Institute and Inova Schar Cancer Institute.
Inova is an organization focused on excellence. From pioneering techniques, to state-of-the-art facilities and advances in clinical care, we know what it means to bring the highest quality healthcare to all who need it. Our mission to provide world-class healthcare - every time, every touch - to each person in every community we have the privilege to serve, is empowered by our values of Patient Always, Our People, One Team, Integrity and Excellence. Our strong sense of shared purpose creates an exceptional experience for our patients and team members alike. Our culture is one of growth and respect infused with recognition and celebration.
Internal Number: 49425BR
About Inova Health System
Inova is a global leader in personalized health, which leverages precision medicine to predict, prevent and treat disease, enabling individuals to live longer, healthier lives. At Inova, we serve more than two million people each year from throughout the Washington, DC, metro area and beyond. Inova's mission is to improve the health of the diverse community it serves through excellence in patient care, education and research. At Inova, more than 16,000 employees demonstrate their commitment every day to providing the community with expert, world-class, compassionate patient care.