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Providence Health & Services Manager of Reimbursement and Recovery in Oregon

Description:

Providence St Joseph Health is calling a Manager of Reimbursement and Recovery to work remotely from one of our footprint states which are inclusive of AK, WA, OR, MT, CA and or TX.

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We are seeking a Manager of Reimbursement and Recovery who will be accountable for:

  • The development, operations and optimization of the acute denials management and prevention processes within Revenue Cycle

  • Working with key stakeholders across Providence

  • Developing and executing strategic plans around denials management and prevention initiatives

  • Participating in, leading, and partnering with others on ORC strategic integration efforts

  • Ensuring a compliant, effective, and streamlined operational experience for business and patient constituent groups

  • Partnering with the Acute Billing Team, Centralized Access Services Team and the On-site Access Services Team

In this position you will:

  • Provide timely reports on denial trends and opportunities to reduce future denials

  • Partner with hospital departments to reduce future denials and medical staff to assist with clinical appeals

  • Partner with Billing and Contracting departments to identify opportunities to reduce future denials

  • Monitor to ensure appropriate use of denial codes by posting department when manually transacted

  • Monitor health plan use of denial codes in electronic files and provide feedback to technical support to ensure appropriate workflow and adjustments

  • Proactively identify opportunities to improve business results and/or to alert business units of trends, anomalies or health plan rules and decisions that need attention

  • Escalate unresolved issues appropriately and recommend solutions to minimize future problems

  • Assist and partner in testing of electronic remittance files to validate data and ensure appropriate workflow

  • Key Metrics:

  • A/R days

  • Unnecessary write offs

  • Denial rates

  • Maintain a working knowledge of the PSJH reporting systems and tools (i.e. Vantage, HANA, Epic, etc.)

  • Maintain a high level understanding of CMS billing guidelines, requirements and coding initiatives.

  • Maintain high awareness of top reimbursement and denial trends across the industry.

Qualifications:

Required qualifications for this position include:

  • Bachelor's Degree or a combination of equivalent education / experience

  • 7 years' experience in integrated healthcare system in any aspect

  • 7 years' experience in a large and complex acute care setting

  • 7 years' experience in knowledge of regulatory billing requirements

  • 3 years Management experience

  • 3 years' experience demonstrating in depth knowledge of the revenue cycle inclusive of: healthcare finance and accounting issues and standards, billing, claims, collections, AR reporting and analysis.

  • 3 years' experience demonstrating knowledge of commercial and or regulatory claims billing including Federal, State and local laws and regulations.

  • 3 years' experience demonstrating standardizing complex and disparate processes and maintaining common processes to standards across multiple facilities and in different settings

  • 3 years' experience demonstrating process improvement methodology, change management and operational improvement in complex systems

Preferred qualifications for this position include:

  • Bachelor's Degree in a healthcare related field

About the department you will serve.

One Revenue Cycle (ORC) is the name adopted to reflect the Providence employees who work throughout Providence Health & Services (PH&S) in revenue cycle systems and structures in support of our ministries and operations in all regions from Alaska to California. ORC’s objective is to ensure our core strategy, One Ministry Committed to Excellence, is delivered along with the enhanced overall patient care experience (know me, care for me, ease my way) by providing a robust foundation of services, operational and technical support, and the sharing of comprehensive, relevant, and highly specialized revenue cycle expertise.

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit

https://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. 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.

Schedule: Full-time

Shift: Day

Job Category: Non-Clinical Lead/Supervisor/Manager

Location: Washington-Liberty Lake

Other Location(s): Montana, California, Washington, Oregon, Texas, Alaska

Req ID: 325334

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