How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.
Work Shift
Day (United States of America)
Job Summary:
Under the direction of the AVP Revenue Cycle Operations, the Manager RC Operations (MRCO) is responsible for overseeing the accounts receivable and revenue cycle operations for the hospitals within the WellStar Health System. The MRCO has 7 main responsibilities: team leadership, revenue cycle operation duties as assigned, financial, reimbursement, denials & adjustments, resource for hospitals, shared services, and vendor leadership where necessary and operational and reporting responsibilities when assigned.
This role requires a versatile and well developed knowledge of billing, collections, technical denials appeal/correction process, and understanding of provider/payor escalation requirements. In addition to a strong understanding and capability of common business technologies such as MS Office, Excel, PowerPoint, Word and Outlook to perform and communicate the assessment and analysis.
Core Responsibilities and Essential Functions:
Job Functions:
The following is a comprehensive but not exhaustive list of responsibilities. Along with the each of these responsibilities is outlined below, other duties may be assigned as needed based on operational and business needs:
Work with financial leaders within Shared Services to complete the month end revenue cycle performance including, but not limited, to the following:
Regularly review operational revenue cycle performance based on a set of defined key performance indicators against targets
Review large dollar financial class changes that affect reserves and accurate statement of monthly net revenue
Collaborates with the vendors and department leaders to explain net revenue variances for the month end.
Work with key stakeholders to determine root cause of variances related to CFB, cash, AR and denials
Team Leadership duties:
Conduct revenue cycle meetings as needed and follow up with vendors (AR related, TPL, Coverage Eligibility) regarding deliverables.
Conduct and drive monthly Denial meetings to help determine root cause and improve processes to reduce denials to benchmark targets.
Development of strategies for establishing a continuous improvement work environment, open and closed technical denial accounts are reviewed, corrected, escalated, or closed within the designated payer time frames and are documented appropriately in the patient accounting system. The role requires extensive data analysis, trending analysis, project management, and departmental educational capabilities regarding payor and revenue cycle payment related processes.
Regular Operational and Reporting Duties:
Assess, review daily work queues, which include the following: Charge, CFB, Adjustments, etc to ensure accounts are being worked timely
Provide oversight and direction of the daily report requests. Reports are as follows: DNFB, CFB trending, AR reports, and other reports as requested
Denials revenue cycle contact for Case Coordination/Utilization Management.
Liaison and point of escalation for revenue cycle customer service requests and issues.
Monitor and assist with CFB resolution as it relates to revenue cycle.
Interface with AR, PAS, SBO, Coding, Compliance as needed regarding the following key metrics:
Total cash collections
POS cash
Denial write offs
Medicaid outliers
Payor trends
Specific accounts reviews
Special account handling that may be needed.
Assists various business units with general inquiries thus improving claims quality and overall cash performance.
Works with…