IPA ADMINSTRATOR

IPA Adminstrator

The IPA Administrator holds an executive leadership position that requires comprehensive knowledge of the managed care industry, familiarity with government regulations, strategic planning skills and an understanding of the finances and operations of an Independent Physicians Association. This individual is the primary interface with the IPA Board of Directors, governing committees, contracted physicians and other medical professionals, health plan representatives and various health care vendors. This individual is responsible for managing all aspects of the IPA and requires an intimate operational relationship with all AMM departments

Job Description and Duties

  • Schedule and conduct IPA Board meetings, IPA oversight committee meetings (QM/UM/Credentialing) as required. Develops agenda items with IPA leadership and AMM Department Managers. Keeps minutes of meetings and maintains action items and monitors follow-up.

  • Work continuously and closely with Medical Director to oversee utilization of health care services, quality of care and medical cost effectiveness. Receive regular updates of daily census, beddays, length-of-stay and admission rates of IPA and credentialed physicians. Make targeted recommendations upon which IPA Committees can take action.

  • Oversight of cash receipts and disbursements, including payments from health plans and capitation and claims payments to physicians and other providers. Manage check signing process.

  • Oversee all record-keeping and reporting of data to Board of Directors and health plans. Develop new reports as needed and interface with AMM report writers.

  • Ensure compliance with all applicable state and federal guidelines and laws, and all health plan directives. Develop new policy and procedure as needed and work with the IPA Board to approve and implement with IPA physicians and AMM operations.

  • At the direction of the IPA Board of Directors, initiate, negotiate and execute all provider and ancillary agreements. Achieve and maintain payment rates and terms favorable to IPA. Analyze major agreements annually to maintain currency.

  • Maintain high level of provider satisfaction. Oversee relations with credentialed and other contracted medical and ancillary providers. Provide physician-specific direction to AMM Provider Office Management staff. Provide education and intervention to solve problems in non-compliant medical offices. Work with contracted providers regarding member grievances, appeals, and other quality of care issues.

  • Analyze current market positioning and make strategic planning recommendations that achieve IPA goals. Oversee marketing, advertising and public relations activities consistent with direction provided by IPA Board. Oversee marketing agencies/brokers and communicate IPA Board direction.

  • Primary liaison to IPA Providers, IPA Patients and IPA Board of Directors.

  • Analyze and interpret health plan agreements including Division of Financial Responsibility, fee schedules, covered benefits and compliance requirements so that AMM systems are programmed correctly and timely.

  • Report regularly and directly to AMM Management and IPA Board of Directors.

Qualifications and Experience

  • Bachelor degree in Health Care Administration or Public Health Administration from an accredited university.

  • Six years experience in IPA management or comparable managed health care experience.

  • Knowledge of applicable state and federal managed care laws and guidelines (AB 1455, Accountable Care Act, HIPAA, Stark, etc.).

  • Experience negotiating health plan managed care agreements and physician and provider agreements.

  • Ability to manage all aspects of business operations, and effectively manage personnel and various projects within time constraints.

  • Must effectively interface and successfully cultivate relationships with various business partners; including health plans, hospitals, and health care providers.

  • Demonstrated communication, interpersonal, and time management skills. Must be able to make presentations, conduct formal meetings, write business letters and effectively use email to communicate complex ideas.

  • Must pay attention to detail and take ownership of assigned tasks.

  • Valid driver’s license and/or dependable transportation to work site is necessary.

  • Must be computer literate and knowledgeable in Microsoft Office, with understanding of EMR systems, and IPA management software.