Employment Type:

Full time

Shift:

Day Shift

Description:

POSITION PURPOSE

Work Remote Position

(Pay Range: $39.8218-$59.7327)

Manages and oversees a team responsible for all post billed denials (inclusive of clinical denials), ensuring payments are received on denied accounts, determining root causes of denials and preventing denials within the Hospital or Medical Group revenue operations of an assigned Patient Business Services (PBS) location spanning across multiple regions accounts receivable and payer environments. Motivates staff to achieve the highest levels of customer satisfaction and to meet the organization goals for customer service, operational and financial performance in order to achieve a world class revenue cycle team. Attends managerial meetings and supports the core values of Trinity Health, which is an integral part of this position. This position reports to the Director Payment Resolution.

ESSENTIAL FUNCTIONS

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.

Manages and oversees day-to-day activities and responsibilities of the payment resolution/denials team handling the receipt, analysis, and appeals of denials received in order to achieve optimal area performance and colleague productivity goals as part of the revenue cycle process for an assigned PBS location. Includes understanding and managing denials populations across both the acute care and physician environments which will span multiple regions, states and payer environments.

Responsible for managing the Supervisor (s) Payment Resolution and subordinate colleagues, and with the assistance of the Supervisor, ensures all denials activities are completed in a timely, accurate and compliant manner.

Assists the payment resolution denials in the development of broader goals and objectives based on PBS needs and ensures continuous improvement in quality, operational cost effectiveness, customer satisfaction and resource utilization.

Develops proposals for the payment resolution denials regarding long and short-term goals, objectives and strategies for the customer service operations. Monitors operations to ensure goals are achieved.

Review denial trends, makes recommendations for resolution of issues and findings from Denials Supervisor(s); report findings to the Director Payment Resolution and other PBS leadership.

Provides Director Payment Resolution with regular updates of results, barriers to performance and opportunities for continued improvement.

Manages continuous quality improvement initiatives across the denials team and other departments within the PBS to streamline processes.

Follows RAC audit findings for charge/billing denials, documentation issues and level of care discrepancies initiating corrective action as needed.

Maintains current knowledge of Medicare, Medi-Cal, Medicaid, and Managed Care billing compliance guidelines and requirements across multiple regions and states, as they pertain to charges, billing and coding.

Reports denial data, financial impact of denials, and the revenue impact differential for issues identified, implemented, or corrected to the Director Payment Resolution, PBS leadership, and others as needed.

Participates with peers across PBS and RHMs including Revenue Integrity Leaders, and the Director Payment Resolution in the redesign of denial management processes and systems to improve service, data integrity, and staff productivity/quality to achieve departmental goals and process outcomes.

Provides education to applicable departments across each the local RHMs (crossing multiple states and regions) that are included in the respective PBS location regarding denials prevention and appeal success rates.

Manages assigned staff to ensure steady workflow balance and high-quality outcomes anticipating and planning for staffing fluctuations:

• Interviews, selects and is accountable for the on-going development and evaluation of colleagues within the area of responsibility;

• Develops colleague work schedules to ensure cost effective staffing that meets customer requirements and financial performance;

• Establishes, implements and evaluates on-going performance improvement programs, utilizing an interdisciplinary approach;

• Responsible for the financial and personnel management of assigned areas, and

• Effectively directs and facilitates a multidisciplinary team to achieve its desired outcomes.

Creates and monitors a culture supportive of personnel by fostering individual motivation, teamwork and high levels of performance and accountability utilizing a participative management style to ensure staff retention. Identifies action plans to improve the quality of services in a cost-efficient manner and facilitates plan implementation.

Maintains professional development and growth through journals, professional local, regional and national affiliations, continuing programs, seminars, and workshops to keep abreast of trends in revenue cycle operations and healthcare in general:

• Develops and implements an annual plan of personal and professional development.

Serves in a leadership role and promotes positive Human Resource Management skills by fostering teamwork between business and clinical stakeholders and by recruiting, retaining, training, mentoring, developing and managing staff to achieve strategic objectives.

Other duties as needed and assigned by the Director.

Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

MINIMUM QUALIFICATIONS

Must possess a comprehensive knowledge of revenue cycle functions and systems, as normally obtained through a Bachelor’s degree in Business or Healthcare Administration or a related field, and minimum five (5) years of experience within the area of revenue management, specifically with Denials or other management functions related to revenue cycle activities or an equivalent combination of education and experience. Experience in a complex, multi-entity healthcare organization across multiple states and regions, or large complex revenue cycle services preferred.

Exhibits superior management skills that emphasize team‑building and strong leadership with the ability to provide clear direction to the department.

Customer service background and working knowledge of computer operations and electronic interfaces. Formal software course training is preferred.

Demonstrated ability to interpret 3rd party payer contract requirements and recommend, design and implement procedures for compliance with regulations and standards

Knowledge of APC’s including NCCI and OPPS error edits.

Utilization management knowledge.

Knowledge of and ability to perform medical records review for documentation requirements.

Supervisory experience required

Must have strong written and verbal communication skills. Ability to communicate and work with patients/guarantors, physicians, physician office personnel, associates, 3rd party payer review personnel, and others to expedite revenue cycle processes to avoid negative financial and/or customer service impact on the facility. Serves as a change agent, coach, mentor, team builder and facilitator.

Must demonstrate strong organizational skills leading a combination of direct and dotted‑line reporting relationships.

Effective critical thinking, problem solving and decision-making skills. Strong quantitative and analytical abilities to process and display data.

Proficiency in Microsoft Office, including Outlook, Word, PowerPoint, and Excel.

Must be comfortable operating in a collaborative, shared leadership environment.

Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

This position operates in a typical office environment. The area is well lit, temperature controlled and free from hazards.

Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues.

Manual dexterity is needed to operate a keyboard. Hearing is needed for extensive telephone and in person communication.

The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions.

Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.

Must possess the ability to comply with Trinity Health policies and procedures.

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigne d

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran