HealthPartners
Senior Manager, Payment Resolution
HealthPartners, Minneapolis, Minnesota, United States, 55400
Job Description
HealthPartners is currently hiring for a
Senior Manager, Payment Resolution.
The Senior Manager is responsible for creating an efficient and effective payment resolution team that's focused on the optimization of net revenue recovery. It leads and manages teams and processes that address technical denials, clinical denials, and underpayments. Additionally, the manager has oversight of all associated vendor partnerships.
Daily responsibilities for the Senior Manager include: Developing and controlling all activities necessary to accomplish project and department requirements, including building relationships with internal and external (vendors) throughout Health Partners. Overseeing the programming of contracts into a contract management system and maintaining relationships with Managed Care payers to assist in the resolution of claims processing issues. Reporting key metrics and outcomes to the Patient Financial Services leadership team and contributing technical expertise to the management team. Extensive knowledge of managed care, governmental and third-party reimbursement structures, and regulations. Collaborating across the organization to identify opportunities for workflow and process improvements, setting goals, measuring process effectiveness, ensuring productivity metrics achievements, and implementing policies and procedures. Providing expertise to the organization related to payer reimbursement data and end-to-end revenue cycle claims processes. The Senior Manager must be an involved leader, who can build trust and influence across a wide variety of stakeholder groups. Critical to this role's success will be this leader's ability to build relationships across all levels of individual contributors and leadership. This is a new position that has oversight of a Revenue Cycle Payment Resolution team comprised of a hospital centralized denial team, a post payment audit team, and a payment variance team. The Senior Manager will have up to five (5) direct reports with total accountability of sixty plus (60+) staff members. The team is comprised of payment variance specialists, clinical appeals nurses, payment resolution coders, denial specialists, and contract modeling analysts. The staff are responsible for contract modeling, validation, payer issues, and writing appeals and reconsiderations.
Required Qualifications:
Bachelor's degree in healthcare administration, finance, or related field. Ten (10) years of management experience within a hospital revenue cycle (e.g., denials management, collections, and reimbursement). Certified Revenue Cycle Representative (CRCR) certification within six (6) months of hire. Prior Epic hospital billing experience (e.g., Epic Resolute) Preferred Qualifications:
Hospital revenue cycle experience within a large/matrixed shared services environment. Experience within an acute care and critical access hospital revenue cycle setting. Hours/Location:
M-F; Days The Senior Manager may work remotely with occasional onsite needs. Responsibilities:
Leadership of Denial and Underpayment Operations (20%)
Direct and administer centralized denial and underpayment recovery operations. Managing centralized team of denial nurses, denial representatives, audit specialists, reimbursement staff and two managers. Lead initiatives for optimizing payment resolution and aligning operations with organizational goals. Facilitate denial management meetings to address denial trends across departments. Participate in executive finance meetings monthly to review performance of revenue cycle metrics.
Strategic Management of Payment Resolution (25%)
Develop and manage strategic initiatives for payment resolution areas, ensuring alignment with organizational objectives. Including the following areas: technical denials, clinical denials, post payment audits and underpayment teams. Interpret and implement complex rules and regulations to address insurance denials and underpayment trends. Monitor and track performance metrics and key performance indicators (KPIs) to drive continuous improvements.
Collaboration and Regulatory Compliance (5%)
Collaborate with leadership, medical staff, billing, coding, utilization review, payer relations, and revenue cycle teams to ensure optimal reimbursement and regulatory compliance. Stay informed of federal, state, and third-party regulations affecting denial and payment resolution.
Denial and Underpayment Prevention and Accountability (25%)
Manage root causes for denials and underpayments, holding departments accountable for resolving process gaps. Guide the denials team to reduce preventable denials, contributing to lower Accounts Receivable (AR) days and higher net revenue recovery.
Operational Efficiency and Performance Analysis (5%)
Provide oversight on metrics tracking, ensuring effectiveness and efficiency in denial and underpayment workflows. Prepare and analyze monthly variance reports for leadership, identifying trends in denials and underpayments by payer.
Staff Development and Management (10%)
Hire, train, and conduct performance evaluations for team members, ensuring a productive, goal-oriented environment. Establish clear work procedures and productivity standards, managing corrective actions as needed. Establish minimum hourly productivity and quality assurance expectations.
Budget and Financial Oversight (10%)
Manage the payment resolution department's budget. Partner with Payor Relations on any single case agreements, apply consistent rules and procedures. Oversee successful recovery of denied and underpaid claims, ensuring timely claim reconsideration and reprocessing.
*Job description rankings/percentages are intended to reflect normal averages over an extended period of time and are subject to daily variances. Quality and efficiency standards should at no time be compromised to meet the average expectations expressed above. Job descriptions are subject to change to accommodate organization or department needs
About Us
At HealthPartners we believe in the power of good - good deeds and good people working together. As part of our team, you'll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.
We're a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.
At HealthPartners, everyone is welcome, included and valued. We're working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.
Join us and become a partner for good, helping to improve the health and well-being of our patients, members and the communities we serve.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.
HealthPartners is currently hiring for a
Senior Manager, Payment Resolution.
The Senior Manager is responsible for creating an efficient and effective payment resolution team that's focused on the optimization of net revenue recovery. It leads and manages teams and processes that address technical denials, clinical denials, and underpayments. Additionally, the manager has oversight of all associated vendor partnerships.
Daily responsibilities for the Senior Manager include: Developing and controlling all activities necessary to accomplish project and department requirements, including building relationships with internal and external (vendors) throughout Health Partners. Overseeing the programming of contracts into a contract management system and maintaining relationships with Managed Care payers to assist in the resolution of claims processing issues. Reporting key metrics and outcomes to the Patient Financial Services leadership team and contributing technical expertise to the management team. Extensive knowledge of managed care, governmental and third-party reimbursement structures, and regulations. Collaborating across the organization to identify opportunities for workflow and process improvements, setting goals, measuring process effectiveness, ensuring productivity metrics achievements, and implementing policies and procedures. Providing expertise to the organization related to payer reimbursement data and end-to-end revenue cycle claims processes. The Senior Manager must be an involved leader, who can build trust and influence across a wide variety of stakeholder groups. Critical to this role's success will be this leader's ability to build relationships across all levels of individual contributors and leadership. This is a new position that has oversight of a Revenue Cycle Payment Resolution team comprised of a hospital centralized denial team, a post payment audit team, and a payment variance team. The Senior Manager will have up to five (5) direct reports with total accountability of sixty plus (60+) staff members. The team is comprised of payment variance specialists, clinical appeals nurses, payment resolution coders, denial specialists, and contract modeling analysts. The staff are responsible for contract modeling, validation, payer issues, and writing appeals and reconsiderations.
Required Qualifications:
Bachelor's degree in healthcare administration, finance, or related field. Ten (10) years of management experience within a hospital revenue cycle (e.g., denials management, collections, and reimbursement). Certified Revenue Cycle Representative (CRCR) certification within six (6) months of hire. Prior Epic hospital billing experience (e.g., Epic Resolute) Preferred Qualifications:
Hospital revenue cycle experience within a large/matrixed shared services environment. Experience within an acute care and critical access hospital revenue cycle setting. Hours/Location:
M-F; Days The Senior Manager may work remotely with occasional onsite needs. Responsibilities:
Leadership of Denial and Underpayment Operations (20%)
Direct and administer centralized denial and underpayment recovery operations. Managing centralized team of denial nurses, denial representatives, audit specialists, reimbursement staff and two managers. Lead initiatives for optimizing payment resolution and aligning operations with organizational goals. Facilitate denial management meetings to address denial trends across departments. Participate in executive finance meetings monthly to review performance of revenue cycle metrics.
Strategic Management of Payment Resolution (25%)
Develop and manage strategic initiatives for payment resolution areas, ensuring alignment with organizational objectives. Including the following areas: technical denials, clinical denials, post payment audits and underpayment teams. Interpret and implement complex rules and regulations to address insurance denials and underpayment trends. Monitor and track performance metrics and key performance indicators (KPIs) to drive continuous improvements.
Collaboration and Regulatory Compliance (5%)
Collaborate with leadership, medical staff, billing, coding, utilization review, payer relations, and revenue cycle teams to ensure optimal reimbursement and regulatory compliance. Stay informed of federal, state, and third-party regulations affecting denial and payment resolution.
Denial and Underpayment Prevention and Accountability (25%)
Manage root causes for denials and underpayments, holding departments accountable for resolving process gaps. Guide the denials team to reduce preventable denials, contributing to lower Accounts Receivable (AR) days and higher net revenue recovery.
Operational Efficiency and Performance Analysis (5%)
Provide oversight on metrics tracking, ensuring effectiveness and efficiency in denial and underpayment workflows. Prepare and analyze monthly variance reports for leadership, identifying trends in denials and underpayments by payer.
Staff Development and Management (10%)
Hire, train, and conduct performance evaluations for team members, ensuring a productive, goal-oriented environment. Establish clear work procedures and productivity standards, managing corrective actions as needed. Establish minimum hourly productivity and quality assurance expectations.
Budget and Financial Oversight (10%)
Manage the payment resolution department's budget. Partner with Payor Relations on any single case agreements, apply consistent rules and procedures. Oversee successful recovery of denied and underpaid claims, ensuring timely claim reconsideration and reprocessing.
*Job description rankings/percentages are intended to reflect normal averages over an extended period of time and are subject to daily variances. Quality and efficiency standards should at no time be compromised to meet the average expectations expressed above. Job descriptions are subject to change to accommodate organization or department needs
About Us
At HealthPartners we believe in the power of good - good deeds and good people working together. As part of our team, you'll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.
We're a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.
At HealthPartners, everyone is welcome, included and valued. We're working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.
Join us and become a partner for good, helping to improve the health and well-being of our patients, members and the communities we serve.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.