Director Operations CPUP Department of Medicine

Responsibilities:

• Department Strategic Planning & Change Management:
• Partners with Chair, COO/ACOO, SOM, and CPUP Executive Committee in establishing annual strategic priorities, implementation plans, and measures of success.
• Provides input for the development of the Department's strategic plan and budget. Facilitates this process in partnership with PENN Medicine Strategic Planning Office, entity leadership, SOM Leadership, and the University.
• Participates in the analysis and evaluation of strategic business plans, feasibility studies, market assessment, marketing plans, data gathering, and preparation of business cases on prospective new programs and opportunities for enhancing revenue.
• Ensures that annual strategic goals are linked to the entity’s and leadership’s performance targets.
• Participates as a member of the Department Leadership in the development of strategic capital and other resource priorities and manages them to achieve maximum benefit to Department.
• Proactively develops change management strategy for major organizational goals such as access to care.
• Participates in population health and health equity goals and achievement.
• Department On-going Clinical Operations:
• Conceives, designs, and implements clinical operations dashboards and metrics to track and report on clinical performance and to foster data-driven decision-making.
• Develops policies to reduce cancellations, bumps, no-show rates, and new appointment lag time.
• Addresses patient complaints.
• Establishes provider productivity standards in coordination with the Medical Director.
• Participates in and supports UPHS patient safety initiatives and clinical effectiveness initiatives.
• Continually assesses operating procedures, and access goals, and takes action to assure continuous quality improvements.
• Oversees personnel schedules to ensure effective coverage of support staff.
• Plans, monitors and manages the operations budget to ensure the achievement of operational and financial goals.
• Assures patient flow through the completion of required check-in and check-out processes.
• Oversees daily appointment scheduling and on-site patient experience to ensure access to care and physician and patient satisfaction.
• Oversees the efficient, effective flow of materials to continuously improve the delivery of quality patient care and customer satisfaction.
• Ensure that all regulatory requirements are met.
• Ensures effective utilization of tools, materials, staff, and financial resources.
• Patient and Environment of Care Processes-: (In partnership with, UPHS and SOM Leadership)
• Ensures all Department facilities and environments of care are clean, safe, and patient friendly.
• Ensures all outsourced services meet agreed-upon service standards in support of all patient care processes.
• Supports the creation of clinical effectiveness targets, improvement plans, and reporting systems to ensure the delivery of high-quality, effective, and efficient patient care.
• Ensures that teams and individuals have the clinical, informational, and organizational tools to serve our patients and customers effectively and efficiently.
• Managing risk and enhancing quality and safety.
• Understanding, monitoring, and adhering to regulatory requirements.
• Ensuring that all department patient-care-related processes deliver high-quality care to patients and their families, that these processes are efficient, effective, and streamlined, and are re-engineered when necessary.
• Incorporates Penn Medicine Experience standards.
• Collaborates in Revenue Cycle
• Oversees physician services cost analysis, focused on identifying and managing physician productivity.
• Facilitates open sharing of practice management and physician productivity data.
• Develops and provides access to statistically valid benchmarking data.
• Provides decision support tools and analytic support through the use of CPT data.
• As one representative of the Department, participates in financial negotiations with third parties, hospitals, and managed care organizations and maintains relationships.
• Directs complex organizational and financial problem-solving and analyses as related to physician services productivity, reimbursement, ICD-9, CPT and HCFA coding, compliance documentation, and site-specific professional, technical, and global fee billing.
• Performs impact analyses of actual or proposed changes in payment methodologies, i.e., APC, MAPS, RVU updates, and fee schedules.
• Manages insurers’ QA Audits and represents the department with any necessary responses.
• Monitors work product and provides reimbursement support and A/R performance of CBO.
• Schedules and oversees education programs for physicians and support staff on reimbursement issues, including appropriate procedure and diagnosis coding, as well as appropriate record documentation needs and techniques.
• Develops practice management profiles measuring physician productivity, compensation and incentive planning, billing and coding compliance, workforce planning, revenue and payment forecasting, budget formulation, and management.
• Workforce Planning:
• In conjunction with HR, responsible for select positions; this includes job posting, submission of position justification, performance management, and ensuring mandatory education compliance.
• Strategizes the recruitment, evaluation, training, and talent development of these positions.
• Administers talent management initiatives for current and future staff.
• Creates and implements succession plans for all positions.
• Implements and oversees the following staff functions: recruitment, development, retention
• Responsible for practice operations effective and efficient organizational design including innovative care team models.
• Regulatory Compliance: (In partnership with CPUP, SOM, and University)
• For all University, UPHS, and SOM staff within the department, ensure that all areas of accountability are compliant with all federal, state, and local regulatory standards and requirements, including JCAHO, Department of Health, funding agencies, FDA, HIPAA, HCFA, DPW, department-specific NIH guidelines and others.
• Acts as department Liaison with CPUP Outpatient Audit, reviews and assesses CPUP findings, resolves any issues, and provides remedial training for identified physicians.
• Manages insurers’ QA Audits and represents Department with any necessary response.
• Reviews, implements and ensures compliance with regulatory and legislative changes for all third parties.
• Acts as Department Liaison and oversees routine audit of billing in accordance with established UPHS guidelines.
• Electronic Medical Records (EMR) and Information Systems
• Is responsible for the development, implementation, and maintenance of policies and procedures to ensure efficient processing of information.
• Oversees chart review process and conducts an ongoing assessment of documentation to insure compliance with regulations and policies.
• Ensures compliance with HIPAA, record filing practices, and all related policies.
• Facilitates the development of technology infrastructure and plans for the Department in partnership with UPHS and SOM CIO.
• Is responsible for systems management including maintaining the network, designing and, or implementing programs, and upgrading equipment processes as required.
• Department Information Systems:
• Facilitates the development of technology infrastructure and plans for the Department in partnership with UPHS and SOM CIO.
• Is responsible for systems management including maintaining the network, designing and, or implementing programs, and upgrading equipment processes as required.

Credentials:

• LEAN or SSBB

Education or Equivalent Experience:

• Bachelor of Arts or Science (Required)
• 10+ years including Direct management experience – minimum 5-7 years. Health care management experience preferred - at least 2 years. (Required)
• Basic understanding of CPT and ICD-9 coding, third-party payer billing processes, pre-certification requirements, and the overall revenue cycle Solid understanding of the purchasing cycle (quote, requisition, purchase order, invoice, payment) and experience using ordering systems. Leadership experience in a large integrated healthcare delivery system that uses an integrated practice management software system to register, schedule and bill patients preferred.
• Master of Arts or Science
• MBA or MHA Leadership experience in a large integrated healthcare delivery system that uses an integrated practice management software system to register, schedule and bill patients.