Manager, Revenue Cycle Operations

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

• Work with financial leaders within Shared Services to complete the month end revenue cycle performance including regularly reviewing operational revenue cycle performance based on defined key performance indicators against targets.
• Review large dollar financial class changes that affect reserves and accurate statement of monthly net revenue.
• Collaborate with 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.
• 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.
• Develop strategies for establishing a continuous improvement work environment; ensure open and closed technical denial accounts are reviewed, corrected, escalated, or closed within designated payer time frames and documented appropriately in the patient accounting system.
• Perform extensive data analysis, trending analysis, project management, and departmental educational capabilities regarding payor and revenue cycle payment related processes.
• Assess and review daily work queues (Charge, CFB, Adjustments, etc.) to ensure accounts are being worked timely.
• Provide oversight and direction of daily report requests including DNFB, CFB trending, AR reports, and other reports as requested.
• Serve as denials revenue cycle contact for Case Coordination/Utilization Management.
• Act as 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 regarding key metrics: total cash collections, POS cash, denial write offs, Medicaid outliers, payor trends, specific accounts reviews, and special account handling.
• Assist various business units with general inquiries to improve claims quality and overall cash performance.
• Work 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.
• Analyze, report, and facilitate monthly meetings related to payor denial trends including monthly trends, A3 Focus (WHS) related to denials, review and process improvement initiatives with key stakeholders, and develop SBAR fatal denial write off analysis.
• Participate in facility meetings: Payer Escalation Meetings and JOCs, Denial/Disputes Utilization Management (present denials and disputes), and Complex Case Meeting with CM weekly to discuss specific patients.
• Promote and contribute 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.
• 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.
• Interact 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.
• Ensure staff follow-up on technical denial claims promptly and is held accountable for aged receivables.
• Conduct regularly scheduled staff meetings to discuss new or modified procedures within department.
• Work 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.
• Ensure 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.
• Review and approve staffs time and attendance records.
• Plan work schedules and assign work to staff to ensure adequate service and coverage.
• Ensure Wellstars policies and procedures are current, and update them as necessary.
• Approve technical denial and administrative write-offs in accordance with the Wellstars Adjustment Approval Policy, and audit staff level write-offs to ensure appropriateness.
• Address/resolve issues relating to patient accounts.
• Assume responsibility for resolving inter/intradepartmental issues quickly and effectively.
• Analyze technical denials reports to identify technical denial trends and issues, communicate issues regularly with Revenue Cycle Analysts, and understand how denied charges are impacting the overall accounts receivable.
• Identify root cause issues relating to technical denials and communicate these issues to the Denials Management & Cash Posting Manager and/or Revenue Cycle Analysts for upstream education.
• Provide assistance with departmental projects and presentations, as needed.
• Maintain and reflect a positive team attitude regarding any special projects or polices that are implemented by the Revenue Cycle or other senior leadership.
• Actively participate and support the efforts of the Revenue Cycle Task Force, as well as other committees as assigned.
• 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.
• 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.
• Maintain effective communications with legal collection groups, the WellStar Compliance department and other agencies, regarding new and relevant issues; 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.
• 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.
• Lead vendor teams, implement Revenue Cycle applications, and lead Work Groups to improve department performance.
• Assist with additional Revenue Cycle related tasks and duties as assigned.

Preferred Leadership Competencies

• 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 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.
• 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.

Required Minimum Education

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

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.

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.
• 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.