Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0 million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

Responsibilities

The Corporate Vice President – Claims Dispute Resolution (the “CVP”) must possess unique combination of legal and clinical expertise, with the ability to analyze, develop, and implement reimbursement strategies that leverage both disciplines. The CVP will lead reimbursement dispute resolution efforts, including claim set optimization, health plan litigation supervision, and reimbursement recovery strategies to improve outcomes for Prime Healthcare, in partnership with Prime attorneys, operations leaders, and PrimEra.

The CVP is responsible for overseeing and advancing managed care reimbursement initiatives across regions, including No Surprises Act claims processes, state-specific claims resolution processes, state fair hearings, ALJ hearings, and other reimbursement recovery opportunities. The CVP will identify, develop, and implement scalable processes and strategies under the guidance of the Chief Revenue Officer and Chairman to maximize reimbursement and operational efficiency.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

Required qualifications:

• J.D. from ABA Accredited Law School
• Member in Good Standing of State Bar (does not have to be California)
• Bachelor of Medicine and Bachelor of Surgery (MBBS) degree, or higher
• At least 2 years of experience as an attorney in a law firm, public sector, and/or in-house position, beyond clinical training and/or experience
• At least 6 years of experience in claims dispute resolution

Preferred qualifications:

• Strong preference for 5 to 7 (5-7) years of prior experience with PHMI or comparable healthcare company
• Strong strategic and analytical skills
• Strong written and verbal communication skills
• Superior time management and priority management skills
• Ability to communicate effectively with legal and non-legal audiences
• Experience coordinating efforts across teams and staff

Pay Transparency

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $176,800.00 to $256,068.80 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Privacy Notice

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf