The Manager of Quality and Regulatory Affairs for Radiation Oncology has responsibility for leading a broad range of activities preparing for and implementing current and future payment reform programs. The Manager of Quality and Regulatory Affairs for Radiation Oncology will report to the SVP of Radiation Oncology and the Director of Quality and Regulatory Affairs for Tennessee Oncology. This role includes collaboration and strategy development that will lead to positive financial outcomes in the midst of payment reform. Responsible for extensive education of implementation plan for successful attestation of specific payment reform programs. Cost and quality performance monitoring and analysis, reporting and data submission oversight, primary liaison and content expert for facility leaders where Tennessee Oncology Radiation Oncology physicians provide services. The primary focus of this position is to successfully guide Tennessee Oncology’s Radiation Oncologists through the various federal incentive programs including the Merit Based Payment System, Value Based Care Program, Radiation Oncology Advanced Payment Program, Bundled Payment Programs, and all future payment reform models as they become applicable to Radiation Oncology. These programs represent the US healthcare systems’ initial transition from Fee for Service to Pay for Quality.
Serve as a subject matter expert for regulations, rules, and best practices regarding quality initiatives, regulatory requirements and health care payment reform policy at the federal and state level.
Maintain up to date knowledge of industry news, changes and trends related to payment reform, regulations and opportunities.
Anticipate and model the financial impact of various payment reform initiatives and communicate with Tennessee Oncology administrators.
Prevent negative payment adjustments by ensuring compliance with applicable program requirements.
Collaborate with leaders within the organization on strategic approaches for specific criteria and data collection for quality and regulatory initiatives.
Lead the identification and oversight of standard data collection, analysis, reporting and monitoring to identify areas of need as related to quality and regulatory issues and recommends ways to improve
Develop, implement and maintain tracking methods to monitor progress related to identified key outcomes related to quality compliance
Drive the use of quantitative quality measures as key to enhancing compliance to identified initiatives
Identifies key outcome and performance measures associated with quality initiatives
Lead implementation efforts related to current Value-Based Payment reform programs and future programs such as MIPS, ACOs, CINs Capitation, Incentive Plans and other Alternative Payment Models.
Responsible for generating, monitoring and analyzing performance of eligible providers and hospitals, and working with other staff to identify mechanisms for intervention and improvement.
Ensure policies and procedures are developed and updated as necessary to coincide with regulatory requirements and quality initiatives
Work with EHR vendors to ensure system is updated accordingly and able to accurately produce regulatory reports.
Travel to facilities as needed to provide education and assistance with payment reform program requirements and implementation procedures to ensure success.
Assist facility leaders with implementation of templates, and other clinical processes necessary to ensure compliance with program requirements.
Ensure successful submission of data to CMS and/or other payers to meet requirements of applicable payment reform programs.
Manager the audit and appeal process of any payment reform programs that Tennessee Oncology’s Radiation Oncology Department is participating in.
Lead the development of communication and education materials related to current payment reform programs and implements change management strategies.
Collaborate with hospital partners regarding Accountable Care Organizations and Clinical Integrated Networks representing Tennessee Oncology’s Radiation Oncology’s interest.
Other duties as assigned.
Travel to all Radiation Oncology Sites. In Middle and East Tennessee and sites on the Georgia border. Travel about 25%.
Bachelor’s degree in health care administration, public health, nursing or a related field, Master’s degree preferred
3+ years of experience in healthcare
2+ years in a role that required big picture thinking with ability to prioritize and reimagine
Strong working knowledge of Microsoft Office Products (Outlook, Word, Access, Excel, SharePoint and PowerPoint) and Internet skills required.
Preferred experience in retrospective/prospective analyses using administrative or EMR databases
Internal Number: 1
About Tennessee Oncology
Tennessee Oncology, one of the nation’s largest, community-based cancer care specialists, is home to one of the leading clinical trial networks in the country.