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Job Description

Location: Chicago, IL

Hospital: RUSH University Medical Center

Department: Patient Financial Services

Work Type: Full Time (Total FTE between 0.9 and 1.0)

Shift: Shift 1

Work Schedule: 8 Hr. (8:00:00 AM - 5:00:00 PM)

Summary:

The Manager, Revenue Cycle Payer Relations is responsible for oversight of payer performance. The Manager facilitates a unified and accurate presentation of data and project related work as it pertains to payer performance, payer claim resolution projects, Joint Executive Committee meetings, and the overall payer performance strategy. The Manager is also responsible for facilitating weekly Revenue and Receivable meetings between Revenue Cycle Leadership and Managed Care Contract Managers. Directs the creation and implementation of dashboards, scorecards, reports, and event specific reporting.

Responsibilities

•Serves as liaison between Rush Revenue Cycle, Case Management, Rush Health, and payer executives to drive payer accountability.

•Communicates/Coordinates with Patient Financial Services leadership team for payer issue identification, resolution and appropriate training.

•Facilitates communication and interaction with payers to continually improve and strengthen the relationships between Rush Revenue Cycle and the respective payers.

•Serves as accountability owner for escalation representatives, directing team in day to day work and strategy.

•Drives payer billing issues through the escalation process in an effort to achieve expedient resolution

•Interprets and communicates contract language for adherence within technical build and follow-up processes.

•Stays abreast of payer policies impacting reimbursement. Communicates such to appropriate revenue cycle stakeholders and facilitates internal remediation efforts to mitigate impact.

•Ensures state and federal legislative changes are communicated to the appropriate team members throughout the organization.

•Develops and maintains statistical tracking for all major payers via monthly payer scorecards reconciliation reports, payment denials, claims projects, claim events, and senior leadership payer meetings.

•Responsible for monthly review, validation, and approval of month end accounts receivable reports prior to release to payers.

•Schedules payer meetings including issue resolution meetings, JOC’s, and JEC’s. Prepares agendas and ensures team is prepped for payer meetings. Document notes and outcomes from payer meetings to ensure accountability.

•Facilitates project tracking database for all payer reconciliation reports, payment denials, claim projects events.

•Develops and maintains standard process for account review of payer issues and submits to health plans for resolution. Performs tracking and trending functions. •Coordinates and manages a standardized claim process with payers which includes staffing, operational requirements, statistical reporting and outcome documentation.

•Facilitates and presents at internal payer opportunities meeting the status of the top payers, to include issues, project summaries, claim event results; provides appropriate supporting documentation.

•Develop, design, and implement a process to produce monthly payer scorecards for all major managed care payers. Provides feedback and statistical analysis to Rush Health regarding contracting methodology, accounts receivable issues and trends; coordinates efforts to develop processes for resolution.

•Seeks to gain needed knowledge for issue advancement and resolution from the AVP for Patient Financial Services, VP of Revenue Cycle, Rush Health leadership, and other Rush leaders as necessary.

•Mentors staff and performs staff evaluations in accordance with Rush policy. Provides developments opportunities to staff.

•Supports strategic planning initiatives and participates in effective execution of planning relevant to functional area(s).

•Monitors functional area performance in connection with these metrics and Revenue Cycle overall performance, proactively identifying opportunities for improvement and communicating these opportunities with appropriate leadership/areas

•Leverage technology to streamline and automate where possible and ensures that automated solutions and applications (Epic and non-Epic) support functional objectives to ensure EBO performance.

•Stays abreast of industry & regulatory changes impacting functional area and Revenue Cycle and identifies potential impact and required changes. Strives to promote best practices within functional area and within revenue cycle.

•Completes special projects for the Revenue Cycle as necessary.

•Performs related duties as required

Other Information:

•Bachelor’s degree in business, finance or related discipline required.

•At least five years of experience required in billing, collections, insurance, technology support, or customer service.

•Must have strong knowledge of revenue cycle business operations.

•Excellent verbal and written communication skills due to direct interaction with senior management.

•Strong time management and organizational skills with the ability to effectively multi-task and meet deadlines.

•Strong problem solving and financial analytical skills.

Qualifications:

•High degree of accuracy for analyses and processes.

•Self-motivated.

•Must have a strong customer service focus.

•Ability to plan, coordinate and implement projects.

•Ability to interact professionally with all levels of employees

•Ability to work amongst diverse teams.

•Aptitude for improving professional knowledge and technical skills through development efforts.

•Must have a high level of integrity.

•Ability to observe payment trends, determine root cause of errors, identify possible solutions and suggest changes to workflows as needed.

•Ability to provide colleagues with necessary documentation and pertinent summaries regarding vendor performance, including productivity, quality audit results, expense analysis and cost reduction measures.

Preferred Job Qualifications:

•Professional certification (CPA, HFMA, Epic system or similar) preferred

•At least one year of leadership experience in a multi-facility, integrated health care delivery system or consulting experience

Physical Demands:

Competencies: Disclaimer:

The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.

Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.

Position Mgr Rev Cycle Payer Relations

Location US:IL:Chicago

Req ID 11763