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Revenue Recovery Manager in Columbia, SC at Providence Health

Date Posted: 6/19/2019

Job Snapshot

Job Description

Providence Health

Founded as Providence Hospitals in 1938 by the Sisters of Charity of St. Augustine, Providence's two free standing full-service hospitals and numerous satellite practices maintain a true devotion to advanced clinical expertise and unmatched compassion. On February 2, 2016, Providence became part of the LifePoint Health network, and shortly thereafter, changed its name to Providence Health to better represent the full complement of its services. Driven by quality, compassion, and Christ, Providence treats the whole person- body, mind, and spirit.
Providence Health is currently looking for an experienced Revenue Recovery Manager to join our team.
Position Summary
The Revenue Recovery Manager is responsible for building and maintaining a system that identifies and organizes underpayments and denials. He/she assists the Patient Accounts Manager with leading the Patient Financial Services Team members to achieve full payment of expected reimbursement. In addition, this individual works directly with the payers, physicians, clinical team members, members of the care management team, and HIM (Health Information Management) to appeal clinical denials timely and appropriately. Accomplishing the expectations of this role decreases collection fees, denial rates, and bad debt. He/She works as an integral member of the Revenue Cycle Team focusing on the details of assuring appropriate reimbursement for services rendered. He/She maintains knowledge of current protocols, CPT, HCPCS, and ICD-9/10 coding methods; facility and professional fee billing applications, and third party payer reimbursement methodology. Routine audit of performance documenting a 90 to 95% success rate will meet expectations; 95% or better exceeds expectations.
He/She will promote effective utilization of healthcare resources through assisting in containing costs, globally and at the individual patient level, i.e., maintaining or reducing denial rates, readmission rates, cost per patient day, etc., at or below targets. Prepares reports of denials activity and accomplishments and submits the report to the Director, Revenue Cycle between the 3rd and 5th business day of the month to meet expectations and before the 3rd day to exceed.
Develops an understanding of utilization review processes and documentation as it pertains to coding and billing patient accounts. Coordinates with Patient Access Services providing denial data for precertification and preauthorization. Provides ongoing education to Patient Account Representatives, Patient Access Services Specialists, Care Managers, and other Clinical Managers specific to realizing maximum reimbursement and decreasing denials. Conducts formal training at least 3 times a year (more if warranted). Oversees monthly Revenue Cycle Steering Committee Meetings and subcommittee meetings.
Communicates with insurance companies, review agencies, patients, hospital departments, and physicians to ensure a proactive approach to preventing and reducing denials. Fosters positive relationships with outside agencies.
Observes and supports hospital policies without reservation. Facilitates change so as to promote the advancement and application of new knowledge about healthcare, and performs other duties as assigned.

Job Requirements

Experience
  • Two years direct experience in a hospital/healthcare setting or other relevant training gathering and analyzing denial trends and coordinating denial reduction efforts is required.
  • Two years plus supervisory or management experience required.
  • Experience dealing with RAC is a must. Prior experience specific to the Revenue Cycle in an acute hospital setting is considered optimum.
  • Knowledge of mathematical, financial, logic, medical terminology, coding and billing methodology is considered a plus.
 
Education
BA/BS Degree or higher in education, business administration, health administration or finance preferred or relative work experience
Location
Providence Health Downtown
2435 Forest Drive

Equal opportunity and affirmative action employers and are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran

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