Sr. Manager, Revenue Cycle Operations

Overview

Unified Women’s Healthcare is a company dedicated to caring for Ob-Gyn providers who care for others, be they physicians or their support staff. A team of like-minded professionals with significant business and healthcare experience, we operate with a singular mindset - great care needs great care. We take great pride in not just speaking about this but executing on it.

As a company, our mission is to be an indispensable source of business knowledge, innovation and support to the practices in our network. We are advocates for our Ob-Gyn medical affiliates - enabling them to focus solely on the practice of medicine while we focus on the business of medicine.

We are action oriented. We strategize, implement and execute - on behalf of the practices we serve.

The Senior Manager of Revenue Cycle Operations is responsible for leading and managing the teams dedicated to optimizing practice revenue and improving operational proficiency through strategic claims management for client practices. This position requires a thorough understanding of the medical revenue cycle, medical coding and billing processes. The Senior Manager is responsible for providing full-scale revenue cycle services to our practices under a contractual arrangement, which may include medical coding validation, charge entry, denial resolution, overall accounts receivable management, general customer service, training, reporting, analysis, and P&L management. The successful applicant will have demonstrated experience in driving continuous performance improvements through data analysis, system optimization, other automation techniques (e.g. RPA), provider education and/or RCM process changes.

Responsibilities

• P&L owner for the enhanced operations service model; responsible for delivering high quality services to practice clients while ensuring high staff productivity, effective cost control, and positive contributions to the company’s margins.
• Ensures productivity and quality management for assigned teams are executed in a fashion that is efficient, objective, and accurate.
• Evaluates and proactively plans for staffing needs as a result of ongoing demand and M&A growth for services.
• Acts as a champion and leader in promoting services to Unified practices with a bias for continuous growth and optimization of the offering.
• Oversight of on-going denial trend research and analysis, including evaluation of payors’ clinical, coding and reimbursement policies spanning all markets, and translating that information into action plans that drive end-to-end performance improvement.
• Manages and supports the operations team by providing leadership, mentoring and strategic direction to drive change and optimization of practice revenue.
• Oversight of vendor performance and operations, through documentation of workflows to track and develop enhancements to processes.
• Mitigates any potential revenue cycle issues, team performance constraints or customer satisfaction concerns and provides timely updates to leadership.
• Prepares and presents practice financial performance data to practice and departmental leadership.
• Assures claim coding is supported by documentation and identifies outliers based on clinical documentation, ensuring accuracy and proper reimbursement
• Performs quality assessments on an on-going basis; oversees the capture and analysis of data regarding operational performance and quality control; ensures all coding is completed with regulatory compliance; develops and maintains productivity metrics.
• Additional tasks as assigned.
  
  

Qualifications

• Minimum of 5 years’ experience in healthcare medical coding or billing environment.
• College degree preferred.
• Minimum 3-5 years leading multiple revenue cycle operational teams.
• OB/GYN practice management experience preferred.
• Intermediate to advanced proficiency in Microsoft Excel and PowerPoint preferred.
• Strong presentation skills, with ability to effectively communicate to Executive and Physician
  
  

leadership teams on KPIs and strategic priorities.

• Excellent relationship building skills and aptitude for working collaboratively with cross-functional
  
  

groups.

• Knowledge of NCDs / LCDs and how to successfully navigate updates to decrease impact to claim
  
  

processes.

• Strong working knowledge of payor denials and policies.
• Able to independently manage multiple tasks and deadlines, with minimal oversight.
• Able to clearly document processes and facilitate knowledge sharing to external users.
• Knowledge of Athena Collector preferred.
• Critical thinker with ability to problem solve, perform root-cause analysis and implement action plans.
• Strong knowledge of payor and clearinghouse claim edits and rules.
• Strong analytical skills are required.
• Ability to handle multiple projects concurrently.
• Excellent customer service, verbal and written communication skills.