Primary Location:

Med Plaza II - UMC

Address:

250 E Liberty
Louisville, KY 40202


Shift:

First Shift (United States of America)

Job Description Summary:

Job Description:

The Revenue Cycle Accounts Receivable Reimbursement Manager oversees the teams responsible for monitoring and analyzing facility reimbursement from government, managed care, and third-party carriers as defined in contractual and federal and state agreements for the UofL Health System.  Responsibilities include data analysis, financial interpretation of contract terms, contract modeling, payment validation, credit resolution, and identifying revenue enhancing opportunities.  This position will collaborate with the Payor Relations and Contracting Department during contract negotiations and settlements on reimbursement issues impacting payment from third party payers.  Additional analysis and reporting to senior leadership and department leaders will be performed as required.

Essential Functions:

• Reviews payer contracts to include analysis of payor charges, deductions, reimbursement data and other key metrics to identify underperforming payers
• Actively participates in cross-functional teams to identify, develop, and implement solutions and process improvements for under-performing program contracts, including improvements in billing, collections, charge integrity, denials, and underpayments
• Oversees modeling process to benchmark reimbursement rates to Contracted Commercial and Managed Medicaid reimbursement levels
• Oversees refund approval process and submission of quarterly Medicare Credit Balance report by CMS deadlines
• Prepares and contributes to establishment and implementation of policies and operating procedures affecting accounts receivable operations
• Keeps Revenue Cycle leadership abreast of issues and concerns that affect cash flow and/or staff efficiency or morale
• Reads, reviews, and analyzes state and federal regulations, charge generating systems, and payor contracts to ensure appropriate and cash maximizing strategies are in place and adhered to
• Prepares summary analysis for major insurance payors based on identified key metrics for management review
• Initiates corrective action with payers to resolve reimbursement discrepancies
• Provides education on regulations, systems, and billing requirements impacting claims from being paid or review of overpayments in determining appropriate refund actions
• Promotes positive staff management skills by fostering teamwork between various stakeholders:  recruits, retains and manages staff to achieve strategic objectives and provides staff with training, mentoring, and development
• Identifies deficiencies in staff performance and backlogs in inventory statistics in a timely manner and take action to address outstanding issues
• Maintains compliance with all company policies, procedures and standards of conduct
• Complies with HIPAA privacy and security requirements to maintain confidentiality at all times
• Performs other duties as assigned

Additional Job Description:

Job Requirements

(Education, Experience, Licensure and Certification)

Education:

• Bachelor’s Degree in Accounting, Business, Business Administration, Healthcare or related field (required)

Experience:

• Three (3) years of revenue cycle processes, auditing, accounts receivable management or healthcare management experience, or equivalent experience (required)
• Five (5) years of revenue cycle processes, auditing, accounts receivable management or healthcare management experience, or equivalent experience (preferred)

Job Competency:

Knowledge, Skills, and Abilities critical to this role:

• Expert knowledge of reading and interpreting payor contracts/rate structures
• Knowledge of CPT/HCPCs, APCs, MS-DRGs, revenue codes, modifiers, and billing regulations
• Proactive - anticipates and plans for problems before they arise
• Strong organizational skills – manages time effectively, keeps tasks appropriately prioritized; perform work in a neat, efficient, well-coordinated, well communicated manner with a high degree of accuracy and professionalism
• Flexible – ability to change directions as needed for the good of the department or organization
• Strong work ethic – motivated, diligent, industrious and persistent in the workplace, stays on tasks to completion, works at a fast pace to ensure optimal efficiency
• Interpersonal skills– able to build effective, strong working relationships with employees, colleagues, management and vendors through trust, communication, and credibility; able to work with, serve, help, lead, and mentor others; take directions from others in the interest of moving process and programs forward to the desired outcome
• Emotional Intelligence – ability to not take issues personal, see the big picture in emotionally charged situations and respond in a mature, professional, composed manner
• Self-Awareness – ability to reflect, understand limitations, and seek appropriate assistance and guidance
• Sound judgment – exercises discretion and due diligence when making decisions and recommendations
• Language Ability:
• Strong ability to communicate effectively in both verbal and written formats
• Ability to read and interpret complex documents including. contracts, claims, instructions, policies and procedures in written form

Reasoning Ability: 

• Able to critically think through complex patient situations, process improvements, evidence-based practice
• Ability to work well with ambiguity and continuous changes
• Able to assist others in developing problem solving/reasoning skills

Computer Skills:

• Proficient in Microsoft Office applications with advanced knowledge using spreadsheets
• Proficient in using electronic medical records systems and billing platforms
• Must have the capacity to learn other relevant systems and databases, as needed

Additional Responsibilities:

• Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times
• Maintains confidentiality and protects sensitive data at all times
• Adheres to organizational and department specific safety standards and guidelines
• Works collaboratively and supports efforts of team members
• Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community