||POSITION SUMMARY:This position is responsible for supervising the operations of payment variances of theNorthern Light HealthPatient Account Services in a Centralized Business Office environment. This position is responsible for a team of account representatives that will be working underpayments and denials. This position will interpret and monitor compliance of managed care contract reimbursement, meet with managed care payers, departmental managers and patient accounting staff to resolve disputes related to accounts receivable and to discuss changes in payer contracts and/or payment policies. In addition, this position is accountable for assessing underpayments and denials to ensure appropriateness for each member hospital of Northern Light Health. This position is responsible for the operational functions of contract management, denials and underpayment applications. In addition, this position works closely with other departments in the revenue cycle within Northern Light Health to provide appropriate payer underpayment & denial oversight and provides feedback that ensures Northern Light Health's continued success in revenue cycle management.DUTIES AND RESPONSIBILITIES:Oversight:· Supervision of all daily operations of the payment variance team. · Analysis of hospital contracts/payment policies to identify payment variances; recommend applicable changes.· Reviews historical payment information to determine accuracy of reimbursement.· Reviews potential payment variances and identifies true discrepancies.· Assist in tracking trends in payment variances & denials across the organization; key performance indicators.· Develop successful payer appeal protocols and processes.· Escalate and resolve payment disputes with payers.· Identify opportunities for process improvement for both client and internal processes.· Maintains personal knowledge base of current managed care trends, reimbursement methodologies, and other important third party payment factors.· Assist in the development of team goals and objectives that adhere to the department and EMHS's financial performance objectives.· Ensure departmental procedures and performance standards are in place and adhered to consistently.· Work closely by way of problem solving with other revenue cycle departments to address payer disputes or changes that directly impact the accounts receivable.· Advises the Manager of issues which may require attention, and makes recommendations to changes needed.· In collaboration with the Manager, maintain high quality employees by way of recruiting, selecting, orienting, hiring, and regularly assessing quality of work.· Provide key and relevant information to the Manager for the fiscal month summary of changes in the accounts receivable.Staff Development/Professional Development:· Supervise designated business office personnel.· Provide employee performance feedback to the Manager and assist in the completion of the employee's evaluation. · Under the direction of the Manager, all employees with an identified performance opportunity are promptly counseled and communicated to timely.· Mentor direct reports while developing a succession plan.· Under the director of the Manager, train staff in the areas of payment variances, healthcare industry processes and standards, communicating and negotiating with insurance companies· Ensure employees are adequately trained, supported, and coached for the development of the department and the individual's professional growth.· Maintain the knowledge of payer policies; attend local, regional, or national conferences/seminars to remain current.· Assess staffing needs on a regular basis to ensure workflows are at the highest quality efficient levels.Other:· Perform other duties as assigned.· Adhere to the professional image of Northern Light Health as a competent and reliable employee.QUALIFICATIONS/EXPECTATIONS:· Associate's degreeor at least four (4) years' experience in a healthcare revenue cycle business management role required.· At least3 years of supervisory experience required.· Detailed knowledge of payer regulations, principles of accounting, reimbursement concepts and automated account receivable systems required.· Knowledge of medical terminology, Current Procedural Terminology (CPT), and International Classification of Disease (ICD) preferred.· Must possess strong supervisory and problem solving skills.· Working knowledge of all areas of the revenue cycle.· Excellent professional communication skills; both oral and written.· Ability to analyze financial and operating information to facilitate decision making.· Proficient with Microsoft business applications.· Experience with Northern Light Health patient accounting software is preferred.· Customer oriented.· Demonstrated ability to lead teams, complete time sensitive projects and work both independently and collaboratively. · Flexible and able to lead change within department.FUNCTIONAL REQUIREMENTS and WORK ENVIRONMENT:· Sedentary work requiring good manual dexterity. Work involves typing, picking, grasping, occasional stooping, kneeling, crouching, lifting up to 10 lbs., reaching and ability to move about to accomplish tasks. Requires repetitive motions of wrists, hands and fingers. Must have excellent hearing and listening skills to receive detailed information through oral communication (via telephone or in person).· Employee subject to inside environmental conditions. Clean, well-lighted, central heat, central air conditioning. Work is performed in close proximity with others. Some noise level from office machines (printers, typewriters, telephones). Ergonomically correct work station.LICENSES OR CERTIFICATIONS:· Certified Revenue Cycle Professional certificate within two years of employment.
Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.