Senior Manager, Revenue Cycle / Patient Accounts, Back - FFS Billed Insurance Recoveries & Pre-Litigation

In addition to the responsibilities listed below, this position may also be responsible for using in-depth knowledge to drive new solutions used by others to process and resolve rejections and denials from insurance payers to ensure service costs are charged; and identifying trends, identifying the root cause of issues, and resolving complex workflow or build issues; using advanced knowledge to overseeing execution and training of the researching, coping, and mailing member-financial records to the respective requestor (e.g., court, attorney, copy services) while implementing process improvements; overseeing the execution of quality reviews and audits and develops and executes the education and coaching process for the verification and validation of insurance coverage discovery, coordination of benefits; partnering and coordinating with vendors to ensure the coverage for underinsured and self-pay patients is completed accurately and in a timely manner while resolving delays in vendors coverage process; promoting and championing innovative coverage programs with other service leaders; leveraging feedback and strategies to develop and execute process improvements for obtaining third party, workers compensation, and secondary coverage payments; using advanced knowledge of the field and critical information from other diverse areas to provide direction to negotiate payment plans to set terms of pay agreement, explaining what is owed, offering discounts, and resolving escalations and implementing prevention with other departments; using advanced knowledge of business practices to coach the organization to providing customer service while explaining the application process, providing direction to the organization to processing applications and disposition, follow policy regulations and provide MFA status, provide quality assurance and ensuring quality standards are being met; assuring alignment with government audits in partnership with other departments; resolve escalations; participates in policy review and recommendation for awarding or denying decisions of MFA committee; developing and executing process improvements to drive team efficiency collects cost-share at time of service or post-service collections based on system deposit schedule and collect payments; ensuring technology is leveraged to perform cash collections; ensuring accountability for adherence and enforcing SOX regulations and conducting remediations; ensuring the consistency of cost-share processes and methodologies at the facility level; issuing complex solutions that require ingenuity, and are used by others to demands for payment of services provided; recommending and sharing new strategies and processes for continuous account monitoring, predicting bad debt exposure, proactive risk analysis, payment terms analysis and overpayment management; ensuring the completion of the teams process form documentation, signature obtainment, and enrollment service locations with Medicare, Medicaid, new facilities, service offers, or commercial enrollment and setting up financial reimbursement with the Treasury; overseeing the enrollment of providers in Medicare, Medicaid, and workers compensation; using advanced knowledge of the payment practices and critical information from other diverse areas to implement strategic solutions; ensuring adherence and enforcing SOX regulations while performing audits and creating action plans; collaborates with Accounting, Treasury, IT and banks to effectively remediate complex payment posting issues; implementing and partnering with peers and source leaders to ensure resolution of the processing of credit cards and refunds by the staff are completed according to statutory timelines while making process improvement recommendations; assisting with research on simple and complex refund inquiries; approval of refund authority within FDA; responding to CMS requests; defining the process of processing bankruptcy, deceased, court decrees, and triage ROI requests in partnership with other groups; redesigning statements, partnering digital engagement to improve online functions, removing barriers, escalating issues, recommending improvements, leading statement redesigns, partnering across teams to resolve issues, implementing industry best practices.

• Creates and advocates for developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; works with leaders and employees to set goals and provide open feedback and coaching to drive performance improvement. Pursues professional growth; hires, trains, and develops talent for growth opportunities; strategically evaluates talent for succession planning; sets performance management guidelines and expectations across teams / units. Oversees implementation, adapts, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends; shares best practices within and across teams. Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams; motivates teams to meet business objectives. Delegates tasks and decisions as appropriate; provides appropriate support, guidance and scope; encourages development and consideration of options in decision making; fosters access to stakeholders.
• Manages designated units or teams by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement; ensures all policies and procedures are followed; partners with key stakeholders and business leaders to ensure products and/or services meet requirements and expectations while aligning with departmental strategies. Aligns team efforts; builds accountability for and measuring progress in achieving results; assumes responsibility for decision making; fosters direct reports to resolve escalated issues as appropriate. Communicates goals and objectives; incorporates resources, costs, and forecasts into team and unit plans; ensures matrixed resources are fulfilling service or performance requirements across reporting lines. Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams and units to operate in alignment with operational and business objectives.
• Ensures the organizations work is in compliance by: actively overseeing and monitoring the teams work while implementing new practices to ensure they adhere to federal and state laws, and applicable compliance standards, and reviewing the monthly quality reports to leadership, and escalating unresolved issues to senior management.
• Ensures accurate patient accounts by: overseeing the management of inquires from providers, members, attorneys, and other insurance personnel to answer a wide range of highly-complex billing questions and evaluating new systems.
• Manages the denial process by: leading a teams highly-complex work of performance affecting denials and ensuring effective remediation and taking the teams data analysis and drawing conclusions including risks when making recommendations while also ensuring the teams complete remediation activities.
• Ensures finances are completed accurately by: working within allocated budget for complex assigned area by monitoring usage and ensuring proper use of expenditures.
• Manages performance management initiatives by: monitoring complex metrics associated with the teams work meets established performance levels while exercising tact and sensitivity in coaching to deliver performance improvement and analyzing financial data and creating complex solutions that require ingenuity, and are used by others to generate reports for relevant departments and medical centers to assess performance progress. uses advances knowledge to ensures quality to oversee performance to enable decision making by providing feedback and driving the implementation of complex strategies to ensure vendor performance of collections, coding services, systems, coverage validation, income verification, reviewing and validating invoices.
• Manages process management initiatives by: using advanced knowledge of the field and critical information from other diverse areas to plan process improvement projects and identify business needs with operations managers, IT, clinicians, and health plan managers while also implementing long-term, complex planning to translate business needs into project requirements that are then used to develop project specifications and action plans.
• Manages project management initiatives by: manages project execution and management efforts by leading team members to collaborate with stakeholders across functions and/or entities to ensure the project is successfully executed and project-based changes are implemented.
• Leads regulatory reporting by: researching, recommending, and ensuring regulation standards are incorporated into complex reporting processes and managing regulatory extracts while also implementing and recommending changes.
• Facilitates with vendor relationships by: maintaining and managing relationship with vendors by working with senior internal and external contacts to manage execution of work in accordance with organizational guidelines while also seeking and using advanced knowledge to recommend complex regional procedures, guidelines, strategies, and methods for managing vendor relationships.
• Manages systems management initiatives by: collecting feedback, providing training, communication, and facilitating the review, validation of the build, preview and comment on adoption of new complex systems updates for highly-knowledgeable teams and escalates complex issues to senior management.
• Facilitates training delivery by: facilitating and delivering complex training, determining training priorities and training delivery methods based on policies, audit findings, and work curriculum.
• Manages the training development process by: using multidisciplinary knowledge of several relevant fields and critical, complex information from other diverse areas to identify education and training requirements that reflect revenue cycle changes to develop strategic training content and providing approval.