Full-timeEstimated: $100,000 - $130,000 a year
- Communication skills
- Managed care
- Project management
- Bachelor's degree
Full Job Description
** Remote working arrangement suitable for qualified candidates **
Summary: Responsible for establishing a best-in-class payor underpayment review team and recovery process. Accountable for payor underpayment operating results, identifying opportunities, engaging key stakeholders by developing action plans, and successfully implementing strategies to reduce payor underpayments. Success in the role will be based on the following: 1) understanding the complexity of managed care rules and regulations, payor payment policies and various reimbursement methodologies; 2) developing a best-in-class payor auditing function grounded in technology to leverage efficiency; 3) identifying improvement opportunities and developing solutions; 4) demonstrating leadership initiative and developing a high-performing team. Responsible for managing audits, projects and audit coordination; meeting with executive and operational management of Parkview to present audit findings; negotiating recoveries and/or settlements with payors and assisting in the preparation of reports for Senior Management. Possesses and applies advanced knowledge of Managed Care reimbursement principles, industry standard coding rules and keeping current on changes in Revenue Cycle functions and third-party payor requirements.
Education: Bachelors degree in business or healthcare related field.
Experience: Seven years of progressive experience in managed care and/or revenue cycle operations leading payor resolution teams and the design of operational improvement identification of audit controls within a process and performing gap analysis. History in working with payor remittance data and denials data. Three years in a leadership role strongly preferred. Strong understanding of governmental and third-party payor contractual reimbursement terms and payment methodologies. Strong leadership analytical process development and project management skills. Ability to foster relationships build trust and provide constructive feedback to improve internal processes that may result in the decrease of payor under payments or administrative burden. Excellent communication presentation and negotiation/persuasion skills. Ability to work in a fast-paced matrix environment managing multiple priorities. Proven track record of developing strong highly productive teams.
Location: Parkview Health · Payor Management
Schedule: Full Time Benefit Eligible, Days, 8-5