- Entry level
- No Education
- Salary $100,000.00 - $125,000.00 gross per year
We're looking for a candidate to fill this position in an exciting company.
Plan, develop and implement all related policies and operating budgets for area of responsibility.
Define strategic objectives as it relates to managed care payer requirements, work closely with internal stakeholders to evaluate and analyze existing systems and processes to implement improvements that support revenue cycle goals.
Build and foster strong working relationships among payers and hospital departments that enhance UI Health's financial performance.
Review third party payer administrative requirements prior to contracting to determine feasibility, impact to operations and implementation needs.
Work with contracting team to attempt to remove items identified as barriers from the negotiated contract.
Summarize final contract administrative compliance implementation requirements for all areas of health system.
Responsible for supporting revenue cycle initiatives and maintaining all aspects of the managed care contract management system(s) including loading/managing managed care contracts in hospital revenue cycle system, auditing new and renewing contracts, working with the internal revenue cycle teams to identify and manage 3rd party payor denials, overpayment and underpayment issues.
Producing ad hoc, weekly, monthly and annual financial reports using contract management and other systems.
Advise Associate Chief Financial Officer, Revenue Cycle of changes in procedures and requirements necessitated by both internal and external factors for managed care payer administrative requirements and issues.
Provide reporting and feedback to various hospital departments for revenue cycle requirements.
Drive leader discussions on implementation.
Work proactively and closely with the compliance team on regulatory matters.
Monitor and report ongoing performance under the contract related to administrative requirements, claims processing lags, denials, bad debt and other key indicators.
Identify opportunities to improve performance under the contract.
Monitor and ensure implementation of payer administrative changes that may occur post contract effective date.
Resolve higher level payer issues impacting UI Hospital.
Develop, educate, and assist various departments with implementation of operational procedures which impact reimbursement from managed care.
Management, development, evaluation and implementation of strategic plans to ensure compliance with contractual terms and conditions of payer agreements and contractual service standards Remain abreast of new and emerging reimbursement and market trends and/or regulatory requirements specifically as it relates to managed care payers.
Gather all current and upcoming payer contract terms.
Understand nuances of contract language.
Communicate with both finance and insurance follow-up areas.
Responsible over build and maintenance of contracts in Epic.
Manage underpayment worklists as well as payer reimbursement performance reports.
Review provider updates and contracts to identify any changes in coverage or processes that affect operations.
Facilitate communications, workflow updates and education required to implement identified payer changes.
Facilitate creation of new payer plans.
Insuring new plan is mapped appropriately related to eligibility queries, work queue assignment and contractual adjustment processing.
Provide end user education on selection and use of plans in EPIC.
Create and maintain database of payer related situation response guidelines to help insure effective and efficient interactions with payers.
Manage relationship with managed care provider representative and facilitate monthly revenue cycle payer meetings.
Work closely with other revenue cycle leaders to understand, document and track ongoing payer issues and work with payer representative to facilitate resolution.
Handle difficult situations in a discreet and professional manner.
Perform other related duties and participate in special projects as assigned
* A minimum of a Bachelor's degree in Finance, Business Management or Administration, Accounting, Communications or related field is required; Master's degree preferred.
* A minimum of seven years revenue cycle and managed care receiveable management and contract experience, and * Within the seven year requirement, a minimum of three years Revenue Cycle related Manager level experience in an academic health system setting.
* Within the seven year requirement, five years of which include managing a hospital billing and collection unit either directly or indirectly * Epic certification in Resolute Hospital Billing Contract Administration.
* Comprehensive understanding of managed care payer terms and administrative requirements.
* Comprehensive understanding of hospital technical reimbursement methodologies, fee schedules, revenue codes, APR and MS DRG, ICD, industry standard hospital billing and claims adjudication practices * Ability to analyze financial and operational information; * Strong hospital, payer and patient communication and relationship building skills are required.
* In depth knowledge of Commercial Managed Care, Managed Medicare, Managed Medicaid and other related revenue management regulatory requirements.
* Ability to work effectively under tight deadlines, high volumes and multiple interruptions * Leadership skills with strong analytical and problem solving skills.
* Ecellent written and verbal communication.