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Director of Strategic Payment Relationships, Pricing Strategy

Roanoke, VA, US, 24011

Job Summary

The Director of Pricing Strategy will provide innovative, influential leadership in developing, evaluating and implementing pricing strategies and tactics for markets, facilities, services and payers across Carilion Clinic.  This position requires a wide range of healthcare financial expertise and experience in both the provider and insurance aspects of healthcare pricing and managed care as well as a high degree of familiarity with local and regional markets. 
 

  • Development of annual CDM strategy for both hospital and physician CDM files.
  • Development and continued enhancement of CDM policies and procedures.
  • Maintain a compliant chargemaster by understanding the constant and continued regulatory and billing changes and implementing those affecting the Carilion Clinic chargemaster timely and efficiently.
  • Oversees the processes to establish and continuously update and monitor the accuracy of the charge master files in various hospital and clinical systems.  Knowledge of annual CPT and quarterly HCPCS updates, compliance to State and Federal billing / compliance regulations.
  • Knowledge and understanding of all charge processes within the organization; provides consultative oversite to staff who assist other department managers/directors with determining chargeable services and appropriate CPT/HCPCS coding.
  • Provides support to fulfill CDM maintenance, reporting and data analysis requests.
  • Enhance the understanding of the Carilion Clinic chargemaster, chargemaster references, chargemaster technology, and the chargemaster’s role in the revenue cycle by serving as a liaison, resource, and educator to the revenue generating departments in all CC facilities and all effected stakeholders.
  • Ability to calculate and communicate the gross and net revenue impacts by facility, service type, and payer related to CDM updates.
  • Direct the work for staff and manages daily employees issues. Conduct full performance appraisals and coaching for direct reports and ensure performance issues are addressed appropriately.  Review team member skillsets to understand how to fill gaps in knowledge or ability.   Plan and provide continuity and succession planning for organization’s key team members.


Step up and lead with a regional leader. Advance your career with an award-winning organization that excels in helping our communities stay healthy and our region grow stronger. Make the most of your management talents at Carilion Clinic, an award-winning healthcare network that includes seven hospitals, multi-specialty physician practices, and affiliations with prestigious academic medical institutions.

Based in Roanoke Virginia, we offer compassionate care, medical education and research, and neighborhood outreach programs. Join and guide a team of caring individuals who embrace and reflect our values‐ collaboration, commitment, compassion, courage, and curiosity‐in all that we do. And realize the advantages of professional stability, strong technological resources, and true advancement potential.

Minimum Qualifications

Education: Master’s degree in business administration or related field required.  Bachelors degree with 10 or more years of experience may be considered.

Experience: Six years of experience in CDM maintenance, government billing for hospital and physician claims, IP/OP charging and coding, government reimbursement or other revenue cycle function.

Other Minimum Qualifications:  Effective management skills including time management, communications, human relations, presentation and organization skills.  Demonstrate clear and concise communication skills, both oral and written.  Ability to conduct in-depth product presentation ins a variety of settings.  Computer literate in office based applications. Knowledge of software to quantify and illustrate issues.  Working knowledge of health insurance practices, industry regulator requirements, business office operations, patient registration, charge master, revenue audit, billing and accounts receivable functions, claim auditing, financial reporting technology and industry standards for healthcare revenue resolution.

Our Values

Below are our core values that we strive to embody and expect of all our team members:

Collaboration: Working together with purpose to achieve shared goals.

Commitment:  Unwavering in our quest for exceptional quality and service.

Compassion:  Putting heart into everything we do.

Courage:  Doing what’s right for our patients without question.

Curiosity:  Fostering creativity and innovation in our pursuit of excellence.

 


Requisition Number: 39456 
Employment Status: Full time 
Location: CASB - Carilion Administrative Services Building 
Shift: Day 
Shift Details: Monday - Friday 8am-5pm. Additional hours as needed.
Recruiter: DAVID L NIVEN 
Recruiter Phone: 540-983-4057 
Recruiter Email: dlniven@carilionclinic.org


This is Carilion Clinic ...

An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious.

Headquartered in Roanoke, Va., you will find a robust system of award winning
hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.

Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us.

Equal Opportunity Employer

Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity

Carilion Clinic is a drug-free workplace.


Nearest Major Market: Roanoke

Job Segment: Neurology, Orthopedic, Medical, Manager, Healthcare, Strategy, Management