Supervisor Revenue Analytics- Hospital Billing-Remote - Lifespan

Summary:

The Supervisor Revenue Analytics reports to the Director Contracting Analytics and Modeling. Under general direction and within Lifespan policies and procedures is responsible for the day to day activities of Contract Management for Managed Care and payers that follow Centers for Medicare & Medicaid Services (CMS) reimbursement for Lifespan and its Rhode Island affiliates for inpatient outpatient and physician billing. Organizes directs and controls programs to identify review and reduce Managed Care and payers that follow CMS denials of coverage. Audits Managed Care and payers that follow CMS actual payments against contracted payments and initiate adjustment process to recover any identified underpayments.

Responsibilities:

Oversees the effective utilization of resources (people financial material and equipment) to meet established operational goals and objectives. In conjunction with the Director establishes priorities to ensure activities support established goals. Interviews directs and evaluates support staff provides guidance and counsel conducts periodic performance evaluations acts as a resource for staff conducts periodic individual and/or group staff meetings prepares and submits payroll provides and maintains subordinate staff development plans develops standards for subordinate staff performance and oversees day to day activity to ensure staff is achieving optimal performance.

In conjunction with the Lifespan Patient Financial Services Department identifies and coordinate all efforts to recover Managed Care and payers that follow CMS reimbursement underpayments as well as implements and monitors contractual compliance of reimbursement terms. Reports non-compliance and payer issues to the Director of Contracting. Assists subordinates in resolving complex situations.

Assists the Director in compiling any necessary statistics needed for follow-up activities.

Provides support to Director in compiling documentation needed to respond to internal and external audits.

Ensures timely and accurate processing of adjustments and denials from payers. Initiates action to resolve accounts. Meets with Managed Care payers Contracting and PFS follow-up staff as necessary to resolve disputes related to accounts receivable and to discuss changes in contracts. Identifies and initiates corrective measures and rebilling of improper denials and underpayments by Managed Care contractors. Documents and reports recoveries and outcomes regularly to Director Vice President and CFO.

Continually evaluates work flow and identifies opportunities to improve process and full and complete payment for hospital services.

Monitors revenue cycle for potential opportunities risks and delays and initiates action to resolve.

Analyzes financial and contractual data used in determining reimbursement compliance. Compiles reviews adjusts and monitors any variances. Ensures accuracy efficiency and integrity of all information systems pertaining to Managed Care denials and reimbursement.

Participates in staff meetings councils quality improvement teams and other such meetings and committees as required.

Designs and develops materials interpreting and communicating results of financial analysis to department heads and senior management. Contributes to development of departmental procedures manual.

Develops and maintains working relationship with Lifespan affiliate departments as needed to ensure full data exchange.

Troubleshoots existing and/or potential problems in the claims processing process recommending changes as appropriate.

Maintains quality assurance safety environmental and infection control in accordance with established policies procedures and objectives of the system and affiliates.

Performs other related duties as required.

Other information:

BASIC KNOWLEDGE:

Bachelor�s Degree in health services administration finance or related field or the equivalent experience.

EXPERIENCE:

Five years� experience in patient accounting including one year of supervisory experience. Ability to interpret Managed Care and CMS contract language. Comprehensive knowledge of patient accounting activities in an automated networked multiple hospital environment. Detailed knowledge of reimbursement schemes for predominant payors. Detailed knowledge of regulatory requirements.

WORK ENVIRONMENT AND

PHYSICAL REQUIREMENTS:

Work is performed in a typical office setting involving prolonged sitting as well as standing and walking.

INDEPENDENT ACTION:

Functions independently within departmental policies and practices. Refers unresolved complex issues to director where clarification of department policies and procedures may be required.

SUPERVISORY RESPONSIBILITY:

Supervision of up to 10 FTEs.

Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Lifespan is a VEVRAA Federal Contractor.

Location: Corporate Headquarters USA:RI:Providence

Work Type: Full Time

Shift: Shift 1

Union: Non-Union