Manager of Payment Integrity - Revenue Integrity/CDM

1. Maintains a professional image and exhibits excellent customer relations to patients, visitors, physicians, and co-workers in accordance with our Service Excellence Standards and Core Values. Keep the Service Excellence statement as first item.
2. Exercises direct supervision of Managed Care Contract Auditors, DM Appeals Coordinators, and Appeals Specialists.  Coordinates workloads, interviews, hires, and trains new employees. Evaluates and counsels employees on work performance and attendance, recommends merit increases, promotions, and terminations.
3. Provides support to the managed care contract negotiation process.
4. Works with Senior Managed Care Analysts to monitor and report managed care contract financial performance.
5. Oversees the daily operations of the managed care compliance system including underpayments and denials management, as well as contract management and compliance operations.
6. Responsible for formal dispute initiatives with managed care payors.
7. Provide dedicated managed care support to other hospital departments as well as Physician Practices, Home Health, and Hospice.
8. Participate and coordinate organizational meetings with contract payers.
9. Coordinate research of employer health plan information.
10. Provide service/code-specific managed care reimbursement as requested by internal departments.
11. Participate in other organizational projects as assigned by Director of Revenue Integrity – Corp, AVP of Revenue Optimization and Single Billing Office, Vice-President of Business Operations, or Chief Financial Officer.
12. Coordinates the timely appeal of all third-party denials and underpayments.

Work Schedule: 80 hours bi-weekly

Qualifications /Training: 

1. Three years experience in provider-based managed care, patient financial services, or denials management operations.
2. Experience in analyzing managed care reimbursement methodologies.
3. Comprehensive knowledge of managed care terminology.
4. Working knowledge of Patient Financial Services applications.
5. Procedural knowledge of hospital and physician practice accounts receivable management.
6. Ability to analyze business problems and opportunities and provide effective practical solutions while focusing on continuous improvement and innovation
7. Excellent verbal and written communication skills

Licenses/Certifications/Registrations/Education:

Bachelors Degree or 3 years management experience within the Revenue Cycle preferred.  High School Diploma with 5 years experience within Revenue Cycle required.

Preferred Experience: Epic Experience in Resolute Hospital and Professional Billing – 2 years