Manager Revenue Cycle Operations

Job Description - Manager Revenue Cycle Operations (2603724)

Manager Revenue Cycle Operations

The Manager of Revenue Cycle Operations is responsible for the oversight of contract modeling, reimbursement analytics, contract management systems and payer performance analysis. This position leads in the development and implementation of best-practice processes that support accounts receivable valuation, reimbursement optimization, contract compliance and revenue cycle performance improvement. The Manager will collaborate closely with Revenue Cycle and Managed Care leadership to drive decision making, optimize contractual reimbursement and ensure operational excellence.

Manages and mentors contract management, Hospital’s Joint Operating Committee(JOC) and analytics staff.

Develops contract models to support payer contract negotiations.

Analyzes proposed contract amendments and payer policy changes to quantify financial impact.

Builds and maintains payer contracts in contract management systems.

Coordinates the team dedicated to ensuring reimbursement calculation accuracy.

Provides detailed reports to Managed Care department for topics including, but not limited to; systemic underpayment issues, accounts associated with payer policy disputes, contract rate modeling, CDM price change analysis compared to contract rates, etc.

Prepares data analysis for Revenue Cycle and Managed Care Contracting leadership which clearly conveys trends and identify key areas for revenue and contract optimization and operational performance improvement.

Monitors and tracks ongoing payer performance through key performance indicators (KPI) in comparison to industry benchmarks.

Directs the efforts of the JOC teams tasked with resolving contested accounts receivable and driving settlement.

Audits staff’s work and participate in developing and delivering training programs within the department.

Creates system and process audit plans. Resolves discrepancies, as required.

Troubleshoots issues and resolve concerns, as well as recommends necessary fixes. Advises management of results and recommend actions.

Creates reports to evaluate accounts receivables and business outcomes.

Cultivates effective collaborative relationships with departmental teams to seek resolution of payer contract and reimbursement issues.

Maintains expert knowledge of Medicare, Medicaid and Commercial reimbursement. Stays abreast of group payer contracts, payer policies, payer plans, and member benefits. Keeps apprised of rules and regulations affecting reimbursement.

Manages special projects and duties as needed or assigned.

Leads the analysis implementation and maintenance of revenue cycle best practice processes and activities.

Bachelor’s Degree and 5 years' revenue cycle, reimbursement analytics, contract management or managed care experience.

Proficient in MS Office Suite including;
Excel (Power Query; BI), Word, Access, Visio, and PowerPoint.

Knowledge of Invision Patient Accounting, Contract Management and/or Claims Scrubber software.

Experience reporting from healthcare decision support, patient accounting, contract management and/or claims scrubber systems.

Knowledge of CPT, HCPCs and ICD-10 coding principles.

Expert knowledge of inpatient and outpatient billing requirements (UB-04, 837i); specifically, how claims information impacts and drives reimbursement.

Expert knowledge of Medicare, Medicaid and Commercial reimbursement methodologies.

Intermediate to advanced proficiency in SQL or Database reporting queries.

Demonstrated analytical skills-ability to break down and quantify problems and processes.

Excellent written and verbal communication skills.

Demonstrated…