Enterprise Payment Variance Manager

Northern Light Health Home Office | ME

Posted Date 4/12/2019
Description Schedule: Regular Full-time
Shift: Day
Hours: 8:00 am-5:00 pm
Northern Light Health Employees ONLY Eligible to Apply




Job Summary

This position is responsible for leading the operations of payer denial resolution, underpayments, and credit balances of the Northern Light Health Patient Account Services in a Centralized Business Office environment. This position works directly with all the Northern Light Health members to ensure the people, processes, and technology are in agreement with the functionality for an optimum revenue cycle workflow. In addition, this position is accountable that all responsibilities are in accordance with policies, procedures, and applicable laws; including metrics related to productivity and quality. This position is responsible for providing coordination, direction, and leadership to achieve ongoing operational quality, productivity, and efficiency as it relates to payer denials resolution, underpayments, and credit balances across all Northern Light Health Member Organization facilities and physician practices.

Education and Experience

· Bachelor's degree or currently enrolled in a Bachelor's Degree program.

· 5+ years of progressively responsible management level experience.

· Certified Revenue Cycle Professional certificate preferred.

Required Minimum Knowledge, Skills and Abilities

· Detailed knowledge of payer regulations, principles of accounting, reimbursement concepts and automated account receivable systems.

· Knowledge of medical terminology, Current Procedural Terminology (CPT), and International Classification of Disease (ICD) preferred.

· Must possess strong management 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.

· Strong organizational skills, working effectively in a multi-task environment.







Essential Functions

People

· Maintains high quality employees by way of recruiting, selecting, orienting, hiring, and regularly assessing quality of work.

· Lead and coordinate ongoing staff evaluation, retention, training and management of policies and procedures.

· All employees with an identified performance opportunity are promptly counseled and communicated to timely.

· Mentor direct reports while developing a succession plan.

· Ensure employees are adequately trained, supported, and coached for the development of the department and the individual's professional growth.

· Create a work environment for employees through team building, coaching, constructive feedback, work delegation, personal example, and goal setting that encourage creativity, open dialogue on work issues, professional growth, and a consistent, high level of performance.

· Work with the Revenue Cycle Informatics team to develop and deploy training for new employees and provide ongoing training as needed.

· Responsible for directly managing at least 20 PFS staff members.

Service

· Work closely by way of problem solving with other revenue cycle departments to address payer issues or changes that directly impact the accounts receivable.

· Develop and provide strategic goals related to payer denials, underpayments, and credit balances to executive leadership.

· Oversee the performance and operations of the denial resolution, underpayment, and credit balance functions.

· Develop and maintain super user capabilities in applicable applications and all related information systems, tools, technologies, and processes; assist other employees as needed to ensure tools are fully utilized to create an efficient and effective department.

Quality

· Proactively diagnose, evaluate, and develop corrective actions for problems identified in revenue cycle operations.

· Ensure departmental procedures and performance standards are in place and adhered to consistently.

· Address issues that require immediate attention; make recommended solutions.

· Assess staffing needs on a regular basis to ensure workflows are at the highest quality efficient levels.

· Monitor and strive to continually improve the collection of denied claims and create collection processes that align expected reimbursement per established contracts to actual reimbursement.

· Develop and revise department policies and procedures as required.

Finance

· Lead the denials resolution, underpayments, and credit balances to be at or above the set Northern Light Health goals and standards.

· Develop departmental key performance indicators as it relates to denial resolution, underpayments, and credit balances.

· Manage and monitor on a daily, weekly, monthly, quarterly, and yearly basis the key performance indicators to identify trends and recommend solutions.

· Develop & track team goals and objectives that adhere to the department and Northern Light Health's financial performance objectives.

· Strive to achieve monthly AR, cash collections, and denial targets and expectations, coordinating with other Revenue Cycle department leaders.

· Approve debit/credit adjustments in accordance with Accounts Receivable Adjustment Policy.

Growth

· Maintains personal knowledge base of current managed care trends, reimbursement methodologies, and other important payer payment factors.

· Maintain the knowledge of payer policies; attend local, regional, or national conferences/seminars to remain current.

Community

· Demonstrate departmental desire to provide community benefits by way of charitable events or contribution outside the four walls of the department.

· Act as a liaison for both internal and external customers and facilitate communication across the system.



Organizational Values

Passion: We demonstrate a passion for caring for others and the pursuit of service excellence in all that we do.

Integrity: We commit to the highest standards of behavior and doing the correct thing for the right reasons.

Partnership: Working together in collaboration and teamwork is more powerful than working alone.

Accountability: We take a responsible and disciplined approach to achieving our priorities and responding to an ever changing environment.

Innovation: We are capable of extraordinary creativity and are willing to explore new ideas to achieve our healthcare mission.

Respect: We respect the dignity, worth and rights of others.

















Safety Requirements

· Assist in maintaining a work environment free from recognized hazards that create a risk or injury to employees, patients, or visitors

· All accidents and incidents are reported by employees within 24 hours and supervisor to submit properly investigated report timely

· Ergonomic evaluations are completed as needed

· When appropriate, assist and support with the return of all workers with work related injuries and illness to gainful employment

Physical Demands

· Sedentary: Exerting up to 10 lbs. occasionally, sitting most of the time, and only brief periods of standing and walking.

· Requires the ability to travel to member organizations as needed

Note: the duties listed above reflect the majority of the essential duties of this job and does not, nor is it intended to, reflect all essential duties that may be required for an incumbent in this job to perform.

Equal Opportunity Employment
Industry
Accounting | Healthcare | Management

Share this job