IPA Executive

RegularExemptGENERAL DESCRIPTION:Supports business goals by addressing service requests from Independent Physician Administrations (IPAs) regarding financial and administrative issues. Resolves issues quickly to maintain strong IPA-Company relationships and supports strategies to reduce the Medical Loss Ratio. Prepares Excel reports to identify opportunities for improving IPA administrative management.ESSENTIAL FUNCTIONS: Keep and provide guidance on contracts and economic agreements with IPAs participating in the network for Company lines of business. Comply with the monthly visit schedule of assigned IPAs to meet and follow up on the issues raised. Establish an IPA liaison with the Company. Provide presentations to IPAs on issues related to products, coordinated care models, and related processes. Guide IPA administrators on operational processes, policies, and procedures about coordinated care models. Ensure Classicare IPAs' knowledge of the False Claims Act, list of exclusions of individuals and OIG (Office of Inspector General) facilities, medical fraud, waste, and abuse, among others. Perform analysis of assigned IPA reports and metrics to identify opportunities for premium optimization and/or cost containment, discuss with managers, establish and monitor work plans, and provide recommendations to improve each group's performance. Administer low complexity Excel reports to provide recommendations to IPAs on projects to follow to decrease medical utilization. Provide IPAs with statistics on the progress of medical utilization projects and advise IPA administrators on monthly capitation reports. Distribute the documentation for the admittance or withdrawal of PCPs to the appropriate departments for the corresponding contracting process. Participate in retention strategies and initiatives targeting PCPs and IPAs. Direct and refer to PCP Service Specialists any service issues related to PCPs in the assigned region for resolution. Prepare monthly reports and/or metrics as established by the Department and monitor CHRAs (Comprehensive Health Risk Assessment) compliance for assigned IPAs. Ensure effective coordination of the Clinical Affairs department resources in implementing programs aimed at managing utilization management of medical services. Participate in STARS project initiatives, HEDIS, and educational activities for IPAs. Participates in quarterly IPA meetings with their PCPs. Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices. May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.MINIMUM QUALIFICATIONS:Education and Experience: Bachelor's degree in Business Administration, Accounting, and/or Finance, preferably. Minimum of three (3) years of service experience with providers in the Health Insurance Industry."Proven experience may be replaced by previously established requirements."Certifications / Licenses: Valid driver's license in the Commonwealth of Puerto Rico is required.Other: Experience in utilization analysis or financial analysis preferred. Knowledge of coordinated care model, including capitation payment systems or other provider payment methodologies. Experience preparing and facilitating public presentations. Knowledge of Excel for report preparation.Languages:Spanish – Intermediate (comprehensive, writing and verbal)English – Intermediate (comprehensive, writing and verbal)“Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento”