Manager, Revenue Cycle Operations

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Job Summary:

Under the direction of the AVP Revenue Cycle Operations, the Manager RC Operations (MRCO) is responsible for overseeing the accounts receivable and revenue cycle operations for the hospitals within the WellStar Health System. The MRCO has 7 main responsibilities: team leadership, revenue cycle operation duties as assigned, financial, reimbursement, denials & adjustments, resource for hospitals, shared services, and vendor leadership where necessary and operational and reporting responsibilities when assigned.
This role requires a versatile and well developed knowledge of billing, collections, technical denials appeal/correction process, and understanding of provider/payor escalation requirements. In addition to a strong understanding and capability of common business technologies such as MS Office, Excel, PowerPoint, Word and Outlook to perform and communicate the assessment and analysis.

Core Responsibilities and Essential Functions:

Job Functions:
The following is a comprehensive but not exhaustive list of responsibilities. Along with the each of these responsibilities is outlined below, other duties may be assigned as needed based on operational and business needs:
Work with financial leaders within Shared Services to complete the month end revenue cycle performance including, but not limited, to the following:
Regularly review operational revenue cycle performance based on a set of defined key performance indicators against targets
Review large dollar financial class changes that affect reserves and accurate statement of monthly net revenue
Collaborates with the vendors and department leaders to explain net revenue variances for the month end.
Work with key stakeholders to determine root cause of variances related to CFB, cash, AR and denials
Team Leadership duties:
Conduct revenue cycle meetings as needed and follow up with vendors (AR related, TPL, Coverage Eligibility) regarding deliverables.
Conduct and drive monthly Denial meetings to help determine root cause and improve processes to reduce denials to benchmark targets.
Development of strategies for establishing a continuous improvement work environment, open and closed technical denial accounts are reviewed, corrected, escalated, or closed within the designated payer time frames and are documented appropriately in the patient accounting system. The role requires extensive data analysis, trending analysis, project management, and departmental educational capabilities regarding payor and revenue cycle payment related processes.
Regular Operational and Reporting Duties:
Assess, review daily work queues, which include the following: Charge, CFB, Adjustments, etc to ensure accounts are being worked timely
Provide oversight and direction of the daily report requests. Reports are as follows: DNFB, CFB trending, AR reports, and other reports as requested
Denials revenue cycle contact for Case Coordination/Utilization Management.
Liaison and point of escalation for revenue cycle customer service requests and issues.
Monitor and assist with CFB resolution as it relates to revenue cycle.
Interface with AR, PAS, SBO, Coding, Compliance as needed regarding the following key metrics:
Total cash collections
POS cash
Denial write offs
Medicaid outliers
Payor trends
Specific accounts reviews
Special account handling that may be needed.
Assists various business units with general inquiries thus improving claims quality and overall cash performance.
Works with facility and shared services departments to resolve various revenue cycle issues, (order clarification, patient status changes, account charging, etc.).
Consistently communicate with Revenue Cycle departments (PAS, AR, SBO, Coding, Compliance), vendors and their staffs to ensure ongoing issues are resolved in a timely manner.
Denials & Fatal Adjustments
Analyze, report, and facilitate monthly meetings related to payor denial trends including the following:
Monthly trends
A3 Focus (WHS) related to denials
Review and process improvement initiatives with key stakeholders and develop SBAR
Fatal Denial write off analysis
Hospital Leadership Activities:
Participant in the following facility meetings:
Payer Escalation Meetings and JOCs
Denial/Disputes
Utilization Management (present denials and disputes)
Complex Case Meeting with CM weekly to discuss specific patients
Promotes and contributes positively to interdepartmental relationships.
Provide positive leadership for the department that promotes an environment of cooperation and learning.
Maintain effective communication with other Patient Financial Services and Revenue Cycle departments
Evaluate best practices suggestions for possible implementation into the revenue cycle processes.
The MRCO may perform complex data analysis and make independent decisions within the scope of responsibility through a shared vision driven by the Assistant Vice President of Revenue Cycle Operations, the Vice President of Revenue Cycle, and other senior leadership. The MRCO interacts with executives, other directors, and all members of the Revenue Cycle within WellStar Health System, including leaders of health information management, corporate compliance, accounting and medical group revenue cycle. External contacts may consist of patients and their families, insurance companies, state and federal agencies, auditors, and vendors. This position reports to the Assistant Vice President of Revenue Cycle Operations.
Secondary Responsibilities
* a.Ensures staff follow-up on technical denial claims promptly, and is held accountable for aged receivables.
* b.Conducts regularly scheduled staff meetings to discuss new or modified procedures within department.
* c.Works with Account Follow up Managers to maintain a leading practice appeals toolkit, which includes template letters organized by type of denial to facilitate hand-off.
* d.Ensures staff maintain electronic and/or hardcopy folders of all appeals filed and all associated documentation used for each appeal to serve as a historical audit repository and for tracking/trending purposes.
* e.Reviews and approves staffs time and attendance records.
* f.Plans work schedules and assigns work to staff to ensure adequate service and coverage.
* g.Ensures Wellstars policies and procedures are current, and updates them as necessary.
* h.Approves technical denial and administrative write-offs in accordance with the Wellstars Adjustment Approval Policy, and audits staff level write-offs to ensure appropriateness.
* i.Addresses/resolves issues relating to patient accounts.
* j.Assumes responsibility for resolving inter/intradepartmental issues quickly and effectively.
* k.Analyzes technical denials reports to identify technical denial trends and issues, communicates issues regularly with Revenue Cycle Analysts, and understands how denied charges are impacting the overall accounts receivable.
* l.Identifies root cause issues relating to technical denials and communicates these issues to the Denials Management & Cash Posting Manager and/or Revenue Cycle Analysts for upstream education.
* m.Provide assistance with departmental projects and presentations, as needed.
* n.Maintain and reflect a positive team attitude, regarding any special projects or polices that are implemented by the Revenue Cycle or other senior leadership.
Must actively participate and support the efforts of the Revenue Cycle Task Force, as well as other committees as assigned.
* a.Maintain ongoing communication with other Revenue Cycle departments, keeping the Director aware of more complex problems and opportunities while maintaining courteous, cooperative, flexible and positive working relationships with all levels of management, employees, physicians, guests and the general public.
* b.Maintain a working knowledge of relevant legal and compliance issues, including but not limited to HIPAA privacy, Fair Debt & Collection Act guidelines, Medicare & Medicaid regulations, as well as state and federal laws.
* c.Maintain effective communications with legal collection groups, the WellStar Compliance department and other agencies, regarding new and relevant issues must maintain appropriate knowledge and skill sets to read and interpret various regulatory requirements that affect technical appeals and denials functions. Maintain appropriate documentation to assure an audit trail of compliance-related activities.
* d.Communicate with and obtain assistance from various type insurance, third party collection, governmental and regulatory agency representatives, in the interpretation of critical regulations and the collection/resolution of patient accounts.
This role leads vendor teams, implements Revenue Cycle applications, and leads Work Groups to improve department performance. In addition, the Manager will assist with additional Revenue Cycle related tasks and duties as assigned.
Preferred Leadership Competencies for This Role:
Drive: Capacity to channel energy to achieve personal and professional goals with a focus on continual innovation and improvement.
Intellectual Acumen: Strong desire to continually search for new information and the ability to adapt to new situations. Desire for continuous learning and has the ability to think in a multi-faceted way to achieve results.
Relationships: Ability to establish and develop relationships and understand the value of effective communication. Courage to seek and ask the right questions and to recognize and understand the importance of listening and building trust.
Focus: Ability to work in a fast-paced environment that requires results. Ability to accept, adapt, and drive continuous improvement, change, and innovation. Makes decisions using filters such as:
1. Quality and Safety
2. Compassionate Care
3. Memorable Experiences
4. Efficiency and entrepreneurship
Individualized Approach: Recognizes that each person is unique and seeks to know individuals and their uniqueness.
Response to Negativity: Ability to replace negativity with positive suggestions and discuss negative situations in private (one-on-one) and never before a group. Understands the importance of being positive when building teams.
Executive Skill: Participates in the creation of goals and a vision. Capacity to lead and persuade others to accept established goals and values. Selects the right talent to ensure the success of the organization.
Creates an environment of continual process improvement responsive to the needs of the customer.
Expected Performance, Behaviors and Results:
The "WellStar Experience": (Must demonstrate a commitment to Service Excellence by):
Creating first impressions, memorable moments and impressions that fulfill the expressed and unexpressed wishes and needs of patients and family members.
Valuing patients and family members as partners in their care.
Having world-class processes in place.
Delivering high-touch care that is reliable, responsive and coordinated.
Focusing on constant innovation and creating improvements.
Celebrating our diversity with sensitivity and understanding.
Embracing the idea that we are all owners of our health system
Performs other duties as assigned
Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

• GED General or High School Diploma General
• Bachelors Business Administration/Management-Preferred

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s):

Required Minimum Experience:

Minimum 10 years experience hospital healthcare preferred, claims processing management, collections or other management, or other management role in a healthcare environment.
Required and
Supervisory experience Preferred and
Minimum 10 years Commensurate related experience to include supervisory experience without Bachelor's degree Required or

Required Minimum Skills:

Establish a climate to achieve optimal performance levels and maintain a cohesive work team.
Demonstrate proficiency in reading UB04.
Demonstrate knowledge and proficiency Payor Appeal submission (technical).
Demonstrate knowledge of billing rules and coverage for all major payors.
Identify where to locate and review state and federal regulations as they relate to all payers.
Access Major payer(s) specific provider websites for claim investigation, correction and resolution path determination.
Identify technical denial trends effecting the revenue cycle and escalate for needed solution.
Analyze all technical denials effecting the revenue cycle.
Create and studies revenue reports/Key Performance Indicators and makes recommendations relative to revenue cycle processes for optimization.
Follow standard escalation process in established time frames.
Demonstrate knowledge and proficiency of claims resolution.
Review staff productivity report on a weekly basis and identify areas of opportunity.
Post adjustments at time of account review.
Create/update department policies and procedures.
Access Major payer(s) specific provider websites for claim investigation, correction and resolution path determination.
Work efficiently under pressure and deal effectively with constant change.
Operate a computer and related applications.
Apply appropriate supervisory, management and leadership techniques in an operational setting.
Work independently and take initiative.
Demonstrate a commitment to continuous learning.
Willingly accept responsibility and/or delegate responsibility.

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