Overall operational ownership for all reimbursement and utilization across payors and entities using Contract Management Applications. Provide subject matter expertise and training support for in-house Contract Management system. Collaborate closely with Finance, Managed Care Departments, and Practice Management Team. Deliver decision support and appeals/recoveries metrics to Leadership.
Manage Revenue Integrity Department to meet organizational financial goals and metrics. Supervise Appeals Analysts to meet metrics on appeals and recoveries using Experian Applications.
Manage vendor relationships and ensure timely, accurate data loading for claims and reimbursement. Train staff on Contract Management applications to optimize reimbursement outcomes. Monitor payer changes, educate teams, and update systems accordingly.
Analyze EOBs, network plans, patient ID cards, and member benefits to identify claim variances. Develop and maintain reporting, KPIs, and Payor Contract Scorecards to ensure compliance and performance.
Identify underpayments, zero pay, downcoding, and take action with appeals to resolution. Maintain managed care fee schedules and develop policies/procedures for Contract Manager application and appeals processes.
Lead revenue integrity projects and provide executive dashboard presentations on work volume, staff, payor, and contract performance.
Experience required: 5+ years in healthcare field analyzing claims and reimbursement data, understanding revenue cycle management, appeals and recoveries, workflow management.
Preferred experience: Team leadership with CMS coding and billing experience.
Education required: Associate degree or >5 years experience in reimbursement methodologies, billing and coding.
Preferred: Bachelor's degree in healthcare realm.
Skills: Proficiency in Microsoft Office (Excel), excellent oral and written communication, professional judgment, multitasking abilities.
Valid driver's license and satisfactory motor vehicle record may be required. Employer participates in E-Verify and is an equal opportunity employer.
- Minimum five years of experience working in healthcare, analyzing claims and reimbursement data
- Knowledge of end-to-end revenue cycle management and appeals/recoveries processes
- Ability to manage workflows and outcomes
- Strong proficiency in Microsoft Office Suite, especially Excel
- Excellent communication skills, both oral and written
- Professional judgment and multitasking capabilities
- Valid driver's license and satisfactory motor vehicle record may be required
- Preferred: Experience leading teams and CMS Coding and Billing experience
- Education: Associate degree or extensive experience in reimbursement methodologies, billing and coding; Bachelor's degree preferred
Location
Columbus, Georgia, US
Employment Type
Full-time
Experience Level
Manager
Remote work allowed
No
Posted
3 weeks ago