Director of Physician Services
Magee Rehabilitation Hospital opened in 1958 as the first free-standing rehabilitation hospital in Philadelphia. The Hospital has over 600 employees and is nationally recognized for outstanding programs in physical and cognitive rehabilitation, with comprehensive services for spinal cord injury, brain injury, stroke, orthopedic replacement, amputation, pain management and work injury. Magee serves as the federally designated Regional Spinal Cord Injury Center of Delaware Valley. Only 14 such centers exist in the country. Magee is a founding member of The Christopher Reeve Foundation NeuroRecovery Network, which provides state of the art rehabilitation therapy.
The Magee Rehabilitation Director of Physician Services is responsible for implementing the mission, vision, policies, goals and objectives of Gaspar Clinic and Magee Rehabilitation Hospital. This position promotes the philosophy and goals of the organization, the development of team relationships and congruent rehabilitation practices. This position is responsible for Gaspar Outpatient Clinic, Admissions, Contract Negotiations, Accounts Receivable, Physician Practice Development and Marketing.
Physician Development (in collaboration with Medical Director)
- Develops full assessment of individual Physicians’ existing attributes in a number of areas including: strengths, weaknesses, self-awareness, self-regulation, internal motivation, empathy, social skills, technical skills, aptitudes, attitudes, and desired areas of improvement.
- Assesses Practice and Organizational needs as related to Physician assessment.
- Explores development opportunities with Physicians that meet individual and practice/organizational needs. Must possess a broad understanding of various internal professional and leadership opportunities, new and varied projects, mentorship opportunities (both internal and external), development opportunities offered through professional groups, workshops/seminars, educational opportunities, and volunteer opportunities.
- Develops written development plans agreed upon by all parties.
- Develops and implements clinic policies and procedures; coordinates efforts of medical staff and administrative staff in the recruitment, development, and performance evaluation of Physicians.
- Responsible for developing multiple education programs and projects that are crucial to the success of the position in order to achieve company goals.
- Assists in assessing Physician practices, training and educating staff on best practices.
- Oversees efforts for recruitment, on-boarding, development, and performance evaluation of employees in collaboration with the Medical Director and Director of Human Resources.
- Works cross-functionally with administration, Physicians and staff to analyze information and use that information to create and execute a marketing plan designed to achieve the following goals: Expansion of services to the community for improved access and affordability, growth of existing services to increase timely access, Physician recruitment, increased margins and productivity.
- Must understand changes in the marketplace, identify growth opportunities, and participate with Senior Leadership, Planning and Development and Marketing and Communications to maintain and increase market advantage.
- Ensures clinic integration within the community through effective communication and community outreach, strong public relations and marketing programs.
- Facilitates and develops special development projects improving access to services such as physical renovation and/or clinic related activities (i.e. Medical Home Model, PCMH, Primary Care Plus).
- Responsible for developing an expansion plan with recommendations on expansion of service areas and development of new and profitable business ventures.
- Monitors referral patterns to specialty practices and from primary care practices in an effort to expand the business to PC providers and retention of in-network business
- Contributes content to the organizational website relating to practice and practice services.
Compensation and Employee Agreements
- Responsible for effectively developing Employee Agreements with Physicians that represent the operating agreement between the Organization and the Physician, including areas such as compensation, accepted behaviors, schedule expectations, on-call expectations, etc. Must be able to clearly articulate expectations for Physicians through the use of Employee Agreements.
- Must be able to define & articulate the driving forces behind compensation plans and Employee Agreements with Physicians are to drive Physician behavior and align behavior with Departmental and Organizational Mission and Goals in a rapidly changing environment.
- Responsible for researching and understanding existing compensation plans and the performance of the plan in meeting stated goals.
- Collaborates with Physicians in developing and implementing a Compensation Model that appropriately utilizes measureable and behavioral subjective items directly tied to Departmental Mission and Goals. As appropriate, will determine a matrix of contingent pay that incentivizes desired behaviors amongst the myriad of options, such as Seniority, Quality (based on data such as health maintenance parameters), Patient satisfaction, Administration, Productivity (number of visits, percentage of practice volume, RVU-based, etc.), Citizenship, Panel size or Capitated lives, Special qualifications, Resource utilization, Overhead/Cost control.
- Performs Physician compensation calculations and reporting.
- Must possess keen understanding of payer contracts.
- Manages all practice third party payer relationships, including monitoring of related reimbursement, negotiation with third party payers, provider credentialing, and maintenance of contracts in collaboration with the Chief Financial Officer.
- Represents the practice in collaboration with executive leadership in its relationships with third party payers.
- Negotiates medical services contracts and analyzes competitor pricing activities.
- Develops systems for reviewing, tracking and implementing the performance of managed care contracts.
- Works with Managed Care Contracting to ensure that all Physicians are appropriately credentialed with managed care plans and keeps abreast of current plan reimbursement rates.
- Develops payer performance and monitoring tools.
Billing and Reimbursement
- In conjunction with the Gaspar Clinic Manager, supervises non-clinical staff to ensure accurate daily co-payment collection (cash, checks and credit card payments, charges and receipts) are accounted for and correct; batches for co-pays and other collections are closed out daily; verification of capitation and eligibility of services occurs as needed; timely completion of tasks in work queues, work lists, and in-baskets; and batch scanning is completed daily for any documents that need to be sent to Health Information Management (HIM) or Professional Billing (PB).
- Provides oversight of the relationship with the practice billing company and actively manages the billing and collections for the practice.
- Must have an in-depth and applied knowledge of the payer environment, patient service delivery systems and federal/state rules and regulations regarding billing processes.
- Interfaces with the Billing Vendor and Finance Department to ensure that appropriate procedures are adhered to and that accurate information is being collected and submitted.
- Establishes and maintains “super bill” and appropriate coding oversight.
- Must effectively manage all departmental activities to assure the efficient and compliant registration, billing, coding of accounts and the timely collection of receivables of Physician Activities; ensures optimal recoupment of charges from third-party payers for the purpose of achieving the departmental goal of maximum revenue and cash flow benefit.
- Provides appropriate training and mentoring to ensure that Key Performance Indicators are achieved in the scheduling of appointments and facilitation of patient services through telephone, e-mail, and direct patient contact.
- Monitors appropriate use of appointment cancellation reasons and evaluates and reports the Executives on identified trends.
- Works with the Gaspar Clinic Manager to authorize double book and over book requests when necessary, ensuring proper staff available to provide support.
- Effectively analyzes clinic activities, resources, and programs and determines optimal reimbursement opportunities. Implements process, compliance, and billing activities to ensure recoupment.
- Responsible for all revenue cycle services including oversight and supervision of registration, patient accounts, coding, billing, collections, charge master, cash and credit, payer contracts, government and commercial audits, vendor relations, and department goals and trends.
- Must have extensive knowledge of third party payer contract negotiations, operating procedures, revenue cycle analytics/ trends and automated billing systems
- Works collaboratively with leaders in finance and in the hospital and related groups as well as with associated Physicians and staff to execute strategic plans, implement and evaluate operational programs, processes, and initiatives pertaining to capture and reimbursement of patient revenue and best practices customer service and financial performance.
Interfacing with Residency Programs
- Oversees management of residency related activities.
- Provides guidance and education to faculty and staff concerning financial and administrative operations of an academic department; assures that all faculty and staff participate in required compliance training.
- Negotiates with affiliated medical schools concerning clinical residency programs.
- Coordinates activities of the Residency Training program by assisting Program Directors with administrative aspects of program.
- Interfaces with Graduate Medical Education (GME) Office to ensure the department is compliant and that the needs of residents are met.
- Must possess the ability to select and evaluate key performance indicators and to tie those indicators to financial targets and agreed upon individual Physician goals
- Monitors provider staff productivity in accordance to budget objectives. Contributes strategies to ensure each entity meets or exceeds budgetary targets
- Measures productivity and facilitates collaborative problem solving and communication with the Physicians and executive leadership.
- Develops, implements, and evaluates methods to ensure effective and efficient use of staff, facilities, equipment, and other resources while maintaining patient care standards.
- Calculates quarterly bonus distributions to Physicians using practice management reports to parse out productive CPTs and credit Legal Work. Maintains Excel workbooks for same. Maintains database of Legal Activity. Maintains data base of Physician compensation for use in disbursement of quarterly "hold-back” payments. Disburses to CFO, CMO, and CEO for approval.
Quality Indicators and Measurement of the Patient Experience
- Develops quality indicators in congruence with organizational Strategic Plan and in compliance with requirements for payment programs, regulatory bodies, accreditation agencies, partnerships, Accountable Care Organization affiliations.
- Manages key indicators/benchmarks for practice success, including quality/incentive programs.
- Actively manages the reporting requirements for compliance with all regulatory agencies governing health care delivery, rules of accrediting bodies, and partnership/Accountable Care Organization requirements for quality indicators.
- Must possess sensitivity to an increasingly regulated industry, and proven experience proactively responding to compliance obligations, the transition to electronic health records and associated meaningful use requirements and exemption provisions.
- Communicates and responds to real time Patient and Family concerns and/or complaints in a timely manner.
- Accountable for Patient Satisfaction Survey scores on patient access, pre-auth/pre-cert/pre-reg, and all other surveyed dimensions.
- Communicates patient experience initiatives to all Physicians and office staff
- Reviews and communicates information and potential solutions regarding patient satisfaction, risk, and operating issues.
- Optimizes clinic operations and patient flow to ensure quality of care provided to patients, including serving as liaison to Guest Relations department.
- Arranges regular documentation audits; presents results to Physicians
- Remains current with documentation requirements to ensure accuracy of documentation and codes assigned based on documentation.
- Improves coding, specificity by educating Physicians, clinicians, and other involved parties regarding the necessity of providing complete and clear documentation.
- Assists the Coding Department when querying Physicians regarding unclear documentation.
Financial and Budget Management
- Must possess excellent financial analyst skills; plans and manages to agreed budgets and defined profit targets.
- Develops, justifies and maintains a fiscal plan (budget) for the practice. Monitors patient revenues, expenses and operating expenses (salaries and capital expense items) and provides appropriate reports to the Administrator/Physician.
- Develop tools and systems to provide critical financial and operational information to Executives and makes actionable recommendations is essential.
- Works with Finance and Clinical Leaders to prepare the annual budget, monitors sections' performance in relation to budget, and develops strategies for improvement and/or the correction of deviations from budget.
- Monitors the profitability of each office or cost center, which could include: satellite offices, technical component services, or specialty divisions.
- Performs cost/benefit analyses for all capital equipment purchases.
- Develops a cost accounting system to determine expenses by RVU.
- Completes a full analysis of the fee schedule annually to maximize reimbursement.
- Enhances operational effectiveness, emphasizing cost containment without jeopardizing important innovation or quality of care.
- Transcribes Physician Hospital-based activity logs (Part A Activity) into Excel Workbooks and calculates totals disburses to Budget Director for use in Medicare Cost Report.
- Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
- Develops understanding of practice workflow and collaborates in Physician practice management office system workflow design and implementation.
- Assists and manages Physician office template design and build.
- Serves as Physician office system Super User support to Physician practice.
- Attends office manager meetings and assesses staff readiness for software adoption.
- Supports system go-live and Physician practice adoption.
- Collaborates with EMR/Informatics and IT Leadership to optimize system utilization, functionality and knowledge.
- Acts as a CMS expert and is responsible for compliance with all laws, regulations, policies and procedures.
- In partnership with Revenue Cycle, Information Technology, Business Development, Finance, EMR/ Quality, Compliance and other Practice Leadership, participates in the strategic development, implementation and ongoing evaluation of compliance management infrastructure within the company and its Physician practices.
- Works with Quality Support Specialists to ensure that Environment of Care standards are met.
- Maintains compliance with HIPAA, OSHA, and Labor Laws.
- Complies with departmental organizational policies and procedures and adheres to external agency requirements.
- MBA, MHA or CPA required.
- Three to five years of Physician Practice management experienced required.
- Strong clinical, leadership, and management skills; good interpersonal and interdisciplinary relationships, a high level of initiative and creative problem solving ability.
- Current on recent rulings regarding MACRA, MIPS, Medicare and other payers.
Physical Demands and Work Environment:
Operates in a professional office environment. Routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets scanners and fax machines.
Proficiency and accuracy with office technologies, specifically all Microsoft Office: Outlook, Word, Excel, Adobe Pro, and PowerPoint.
General hospital exposure. Must follow standard precautions.