Description: Job Summary/Purpose Leads system revenue integrity and contracting teams to support daily clinical operations and revenue cycle services. Enhances effectiveness of net patient revenue realization and minimizes revenue leakage across the system (hospital and physician). This involves capture of patient revenue throughout the system. Ensures the CDM is maintained and in compliance with payer rules. Provides system education of CMS and other payer updates. Manages annual system strategic pricing project. Responsible for the payor contracting team (contract analysis, variances, and Epic build) and coordination of payer negotiations. Supports internal auditing for compliance.
Department Description The Regional Business Office is responsible for the accurate and timely follow- up on claims for services provided at all lines of business in all service locations.
Experience/Education/Qualifications Bachelor’s degree in Business, Health Administration or a related field; or equivalent related experience required. Six (6) years of applicable revenue cycle management experience required. Experience with charge master management for a medium or large size health system required. Experience in the following required: Collaborating with healthcare collection/billing practices, coding, finance, patient access, and clinical operations. Patient accounting and billing systems (EPIC preferred). Process improvement (Lean experience preferred). Experience in payer contracting terminology/methodology required. Contract negotiation experience preferred. Experience in Microsoft Office (Outlook, Teams, Word, PowerPoint and Excel) required.
Knowledge/Skills/Abilities Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management. Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner. Critical thinking – Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions. Communication and team building – Leads effectively with excellent verbal and written communication. Delegates and initiates/manages cross-functional teams and multi-disciplinary projects. Comprehensive knowledge of clinical documentation and coding, including CPT and HCPCS. Thorough understanding of the relationship between codes and revenue in the reimbursement process, specifically how revenue is generated from CPT codes and the HCPCS. Firm understanding of the Medicare IPPS, OPPS and ASC payment systems. Strong understanding of compliance requirements. Audit program knowledge (RAC, OIG, etc.). Ability to analyze and report data/information to operations/finance/executive leadership.
Specialty: Accounting
Sub Specialty(S): Revenue Cycle/Revenue Mgmt Specialist
Minimum Years Of Experience: 6
As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
Seniority level
Entry level
Employment type
Full-time
Job function
Finance and Sales
Industries
Staffing and Recruiting
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