Providence Health & Services Manager, Contract Reimbursement Auditing in Portland, Oregon
Providence is calling a Manager, Contract Reimbursement Auditing to Providence Health & Services in Renton, WA or Portland, OR.
We are seeking a Manager, Contract Reimbursement Auditing to supervise Contract Specialists and Contract Reimbursement Analysts responsible for review, follow-up, and root cause and payment analysis. The Manager ensures payers are in payment compliance with their contracted rates and achieving system-wide reimbursement targets. The Manager must stay current on changing government reimbursement methodologies, evolving payment mechanisms of commercial and regulatory insurers, Epic technology and revenue cycle processes.
The Manager collects and prepares data, analyzes payer payment discrepancies and trends determines payer performance, leads staff development and creates efficient work flow processes. The Manager must be knowledgeable regarding the various attributes of multiple unique payer arrangements throughout the system. The Manager must interpret, analyze and make recommendations as to process improvements in all aspects of reimbursement recovery and contracting. The Manager will work directly with payers on questions related to reimbursement performance. The position has responsibility for the accuracy and timeliness of auditing contract loads for expected reimbursement. Performs a variety of projects related to contract reimbursement and growth and development of the team.
In this position you wil l:
Provide oversight and leadership of Contract Specialists and Contract Reimbursement Analysts; responsible for training, development and management of the day-to-day performance of those individuals.
Work closely with IT to maintain reliable and accurate contract calculation functions to monitor payer performance; Establish work processes to audit accuracy of contract loads in systems.
Develop best practices to recover lost revenue based on specific account characteristics of underpaid claims.
Investigate the root cause of underpayments with the goal of eliminating them in the future; Train staff and develop tools to identify patterns and trends.
Respond timely with solutions to identified issues, such as contacting payers for additional reimbursement, suggesting table modeling adjustments, making contract term corrections in PIC or EPIC, and identifying billing or registration issues.
Develop useful and consistent reporting to capture the following: cash collections, global payer issues, payer performance, false variances impacting data and financial integrity, cash posting issues.
Provide support in the development of reimbursement methodologies by identifying opportunities to amend future contracts so as to eliminate or reduce variance situations.
Make recommendations for continuous quality improvement in application systems, reporting and operational areas.
Required qualifications for this position include:
Bachelor’s degree in Accounting, Management or Business.
8 years of related experience in finance, contracting or a related field.
Preferred qualifications for this position include:
Master’s degree desirable – MBA preferred. (Extensive, commensurate experience specific to leading insurance accounts receivable and/or full revenue cycle will be considered).
Previous supervisory experience.
About the department you will serve.
Providence Strategic and Management Services provides a variety of functional and system support services for all eight regions of Providence Health & Services from Alaska to California. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Finance & Accounting
Other Location(s): Oregon-Portland
Req ID: 170911