Job Responsibilities
Contracting with physicians, hospitals, X-ray facilities,
labs, etc. to provide services to health insurance customers.
Managing the relations between the providers and the health
plan. Working closely with medical management, health services,
sales and marketing, quality and credentialing, and finance to
coordinate efforts around having the broadest-possible network
at the best costs.
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Job Requirements
I had no real career plan after graduating from college, but
fell into accounting. After several years in manufacturing, I
ended up working for a Planned Parenthood clinic as the Finance
Director, and was immediately "hooked" on healthcare. Although
I'm no longer strictly a "finance" person, my financial
background has been very attractive to employers and it was
relatively easy to learn reimbursement methodologies and
contracting as well. I have now been in healthcare for 14 years
and can't imagine doing anything else.
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Uppers
Although our current healthcare delivery system in the US is broken, and we are
apt to see many changes in the coming years, I still get a great deal of
satisfaction out of making it possible for people to access the healthcare
services they need at reasonable prices. I also find it rewarding to help
physicians and other providers get their issues with insurers worked out, so that
they are getting paid promptly and fairly for their services. On days when I
persuade a doctor to stay contracted with the HMO and improve their satisfaction
with the health plan, I know that I've done something good for the community of
health insurance subscribers that we serve.
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Downers
In general, I have not enjoyed working for for-profit health
insurers, because the focus is strictly short-term gain, which
can interfere with building strong partnerships with community
physicians and finding 'win-win' solutions. I also find it hard
to deal with when a physician is so disgusted with the treatment
that he/she has received from HMOs in general or the one I work
for in particular, that they won't work with you at all. It's
also hard to be negotiating contracts with "too many cooks" in
the background- if your boss or peers are always trying to
second-guess your decisions or tactics, it's very frustrating.
Negotiating is an art as well as a science and you can't do it
by committee.
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Lifestyle
Most physicians and other providers are a bit suspicious of HMO people who are
"dressed to the nines"- one colleague of mine insisted upon wearing Brooks
Brothers suits to every meeting, which I could tell turned the docs off. They
appreciate professionalism but you don't need to impress them with how much money
you make. Hours can be quite long and often, you have to do very early morning
or late evening meetings, to avoid interfering with a doc's scheduled patients.
As you gain credibility and trust, you will be invited to office grand openings
and the like- very important to attend. I have not found that being a woman is
a barrier to the docs that I work with, but it has impeded my progress somewhat
as an executive. You only need to review the names of "C" level individuals at
any HMO to find that there just isn't a lot of diversity there. I have also
found that gay and lesbian coworkers are very well accepted by docs and coworkers
(for some reason, lots of gay men flock to healthcare, in my experience), and
there doesn't seem to be much racial prejudice either- at least, not from the
docs. Again, HMO execs are overwhelmingly middle-aged straight white guys.
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Compensation
My most recent salary was $140K, plus a 20% bonus potential. In
my previous position, my base salary was less ($112K) but the
benefits were better- there was an executive compensation plan
that included life insurance for me and my spouse, long-term
disability, and deferred cash, among other options. The bonus
was also about 20% of base salary and was based on reasonable
and achievable goals. I got my bonus every year in that job,
whereas in the higher-compensated one, I didn't get a bonus, due
to company underperformance.
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Advice to Jobseekers
Changes are coming in healthcare and no one knows for sure what
the new models will look like. But if you're looking to make a
difference in healthcare but don't want to be "hands-on" like a
doctor or nurse would be, this is a good alternative.
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