Description

Summary:

The Manager Reimbursement position is responsible for assisting in managing CBO responsibilities, including payer audits, commercial billing, Hudson Valley Cardiovascular Practice (HVCP) AR follow-up, and analytical review of the AR. This position will lead and participate in reimbursement related projects to support Revenue Cycle leadership.

Responsibilities:

1. Assists areas of billing, AR, audits pertaining to HVCP by leading and providing operational directives.

2. Manages staff to include conducting performance reviews, overseeing staff educational development, and provide counsel and discipline as needed.

3. Assist management team on other AR related projects, including HVCP as well as Medical Group, if needed.

4. Responsible for identifying audits, logging information into the tracking software, providing supporting documentation, generating appeals, and complying with all government regulatory requirements to satisfy audits.

5. Works collaboratively with clinical areas on documentation to support audit requests.

6. Works collaboratively with departments to improve workflow and or any changes to reduce denials.

7. Reviews and maintains all statistical reports to monitor trends and determine operational deficiencies and implements corrective action plans as necessary. This requires that knowledge of current regulations and policies of the Federal, State, and private payers is maintained and that impacted departments are informed of changes, revisions, and updates. Confirm the integrity of all commercial payor audits received by validating contract terms and requirements with all commercial payors.

8. On a monthly basis, the Manager Reimbursement will publish reports identifying trends related to payer denials, includes analyses of areas of improvement to improve audit results.

9. Assist staff and oversees billing, audits, HVCP AR follow up.

10. Create monthly AR reporting to senior leadership on HVCP performance.

11. Works with senior leadership on strategic improvement of operational efficiency though current systems and processes as well as including clinical areas to reach top decile top quartile achievements.

12. Ensuring all billing activities are compliant, work with compliance to develop annual audit plan. Participate in monthly revenue cycle compliance meeting and assist in issue resolution.

13. Ensures compliance with external regulatory requirements in addition to the internal policies and procedures of the revenue cycle.

14. Conducts internal and external benchmarking regarding the Revenue Cycle seeking operational improvements or gained efficiencies through established KPIs.

15. Maintain and Model Nuvance Health Values.

16. Demonstrates regular, reliable, and predictable attendance.

17. Performs other duties as required.

Requirements:

Education and Experience Requirements:

• Bachelor’s Degree required or equivalent years of experience in lieu of.

• Minimum of ten (10) years healthcare experience required.

Minimum Knowledge, Skills and Abilities Requirements:

• Microsoft Outlook, Microsoft Office, Internet Explorer, Payor Website Navigation.

• Requires that knowledge of current regulations and policies of the Federal, State, and private payers is maintained and that impacted departments are informed of changes, revisions, and updates.

Working Conditions:

Manual: significant manual skills/motor coord & finger dexterity

Occupational: Little or no potential for occupational risk

Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force

Physical Environment: Generally pleasant working conditions

Company: Nuvance Health

Org Unit: 1826

Department: Patient Accounting Med Practic

Exempt: Yes

Salary Range: $43.92 - $81.56 Hourly

We are an equal opportunity employer

Qualified applicants are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other classification protected under applicable Federal, State or Local law.

We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation or our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to ensure that you are considered for current or future opportunities.