HCA, Hospital Corporation of America Director of Payment Compliance Analysis Urgent Care in Coppell, Texas

The HCA Physician Services Group (PSG) is the physician and practice management solution for the Hospital Corporation of America (HCA). PSG operates more than 750 practices, Urgent Care Facilities, and partners with HCA’s 165 hospitals to structure employed provider programs, professional service agreements, and joint ventures that offer the communities we serve high quality, cost effective care. We manage a collection of highly motivated and innovative leaders who are committed to excellence in every aspect of their career .

  • O PERATIONAL DUTIES INCLUDE BUT ARE NOT LIMITED TO: * /Managed Care / Payer Relationship/ • Interacts with payer representatives to resolve issues identified by payment analyses • Assists Managed Care team as needed with contact negotiation requests and payor compliance feedback • Develops overall contracting fee schedule model best practices knowledge-base • Researches alternative payment methods to ensure payer pricing strategies are maximized and organization goals are achieved

    /Contract Modeling/ • Manage all aspects of contract modeling and contract archiving systems • Directs the review and provides managed care contract interpretation, ensures correct and consistent loading of new contracts and fee schedules, and validates contract modeling calculations • Audits contract documents data integrity, accuracy, and reliability • Understand and communicate contract specific issues related to discount and allowance calculations for a variety of payers such as Medicare, Medicaid, HMO’s, PPO’s, IPA’s, employers, etc.

    /Payment Analysis, Payer Reporting and AR Valuation/ • Proactively identify, research, understand, and resolve payer issues that impact the business success • Prepare and analyze data related to payer reimbursement including key payment compliance indicators (e.g. discrepancy rates, overturn rates and other contract performance indicators) • Monitors market, government, legal, industry and other sources for issues, information, changes in regulations and general recommendations regarding pricing • Direct the development of key performance indicator related payer reports/scorecards • Conduct payment audits using claims data and other data sources to ensure payer compliance with contractual reimbursement terms
    • Manage all aspects of accounts receivable valuation tools • Monitor trends and communicate significant shifts in market or operating conditions to Service Center and Practice leadership

    /Other Duties/ • Identify opportunities to enhance system functionality to more efficiently meet business goals and objectives • Identify and implement process improvements • Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement” • Other duties as assigned


    • Organization - proactively prioritizes needs and effectively manages resources

    • Communication - communicates clearly and concisely

    • Leadership - guides individuals and groups toward desired outcomes, setting high performance standards and delivering leading quality services

    • Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations

    • Tactical execution - oversees the development, deployment and direction of complex programs and processes

    • Policies & Procedures - articulates knowledge and understanding of organizational policies, procedures and systems

    • PC skills - demonstrates proficiency in Microsoft Office applications and others as required

    • Financial management - applies tools and processes to successfully manage to budget
    1. Project Management - assesses work activities and allocates resources appropriately
    • Working knowledge of financial and legal contract terms, managed care theory, physician practice or hospital billing/reimbursement strategies


    • Bachelor's Degree in accounting, finance or healthcare administration related field

    • Equivalent work experience may substitute degree requirement


    1. Payer analysis experience
    • Prefer 3 to 5 years of payer financial and/or utilization analysis and reporting experience

Title: Director of Payment Compliance Analysis Urgent Care

Location: Texas-Coppell-CareNow - Primary Health Inc

Requisition ID: 24900-51822