Manager, Payment Integrity

🕒 il y a 20 jours

⚔️ Virginia – Distant

⚔️ Virginia – Remote

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👔 Manager

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Inova Health

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10 000+ employés

Inova est le principal fournisseur de soins de santé à but non lucratif en Virginie du Nord, offrant une excellence clinique de classe mondiale à tous les membres de nos communautés avec une approche chaleureuse et humaine. Nos plus de 22 000 collaborateurs collaborent pour atteindre des objectifs de santé individuels et collectifs en partenariat avec chacun des plus de 2 millions d'individus que nous avons le privilège de servir chaque année, couvrant des spécialités allant du cancer à la neurologie, à la gynécologie, aux soins néonatals et bien plus encore. Les résultats parlent d'eux-mêmes : les soins d'Inova sont régulièrement reconnus par les Centres de services de Medicare et Medicaid (CMS), U.S. News & World Report Best Hospitals, Leapfrog Hospital Safety Grades pour l'excellence et l'American Nurses Credentialing Center. Qu'il s'agisse d'aider chacun à rester en bonne santé, de traiter une maladie ou de réparer une blessure, nous avons les compétences et la compassion pour répondre à chaque besoin. Nous sommes Inova : votre partenaire santé, pour la vie.

Description

• Creates and enforces work standards, quality measures, and process improvements that are consistent with the organization's goals and objectives. Ensures regulatory compliance with Medicare and state authorities, Generally Accepted Accounting Principles and any external governing authority. • Assures claims are reviewed, corrections are identified/made or resolutions are initiated while ensuring all follow-up claims/actions are submitted via the appropriate medium and with all required attachments. • Evaluates the impact of new or upgrades to existing systems/tools while performing testing of system changes, providing technical/operational support during implementation and evaluating the success of new systems/tools. • Ensures timely/accurate billing, collection, posting, servicing, and/or auditing of the $1.5 billion receivable stream. • Ensures follow-up is completed utilizing TRAC work lists, QMS, or other systems/reports according to department policy/procedure, SRG, or industry best practice standards. • Demonstrates a working knowledge of CareMedic systems, DSS electronic billing systems, Syntellect IVR systems, HealthQuest 2000, QMS, and Premis electronic billing systems. • Provides feedback and training to supervisors and staff. Provides resolution for pended (WIP backlog) claims within allowable timeframes (as defined for appropriate deficiency) and/or ensures billed claims receive timely and appropriate follow up based on established protocol or SRG. • Oversees assigned department or functional area to ensure it is performing effectively, which may include but not limited to, hiring and training team members, creating and implementing business strategies, managing performance of team members, and delegating tasks.

🎯 Exigences

• Experience: Four years of experience in Revenue Cycle, Clinic Operations, Credentialing, Denials Management and/or HB/PB Operation roles; Two years in leadership roles • Education: Bachelors Degree or lesser educational degree with four additional years of experience • Strong proficiency in Microsoft Excel (advanced formulas, pivot tables, financial modeling, dashboards). • Proven experience in financial analytics and reporting across areas such as revenue cycle, accounts payable, and/or supply chain operations, including performance metrics (e.g., Net Revenue, AR, Denials, Cash, payment accuracy). • Experience with payment processing, claims adjudication, accounts payable workflows, or supply chain financial operations, with a strong understanding of compliance and cost control. • Skilled in process improvement, workflow optimization, and ensuring accuracy, timeliness, and completeness of financial and operational data across functions. • Strong communication and presentation skills, with experience translating complex financial and operational data into actionable insights for leadership.

🏖️ Avantages

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program. • Retirement: Inova matches the first 5% of eligible contributions – starting on your first day. • Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans. • Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost. • Work/Life Balance: offering paid time off, paid parental leave, and flexible work schedules