Manager, Payer Clinical Services – HBA

🕒 September 2

🇺🇸 United States – Remote

💵 $90k - $120k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 14%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Trend Health Partners

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2018

🏥 Healthcare

⚕️ Healthcare Insurance

💳 Fintech

💰 Private Equity Round on 2023-01

Healthcare • Healthcare Insurance • Fintech

Trend Health Partners is a healthcare technology company focused on enhancing payer-provider collaboration to improve financial management in healthcare. By leveraging AI-enabled technology, Trend Health Partners offers solutions to reduce credit balances, minimize payment denials, and ensure payment accuracy, ultimately fostering better relationships among stakeholders in the healthcare ecosystem. With a commitment to neutrality and efficiency, they aim to reshape the healthcare financial landscape for the benefit of providers, payers, and patients alike.

📋 Description

• Oversee hospital bill audits (HBA) outpatient and facility reviews for accuracy and compliance with internal policies and industry-standard guidelines • Identify gaps and improvement opportunities and provide staff education to enhance audit quality and drive revenue performance • Apply industry-standard coding guidelines, payer policies, and relevant audit-review references • Maintain strong client relationships through accurate clinical and coding audits and understanding of client issues and needs • Identify client denial trends and report findings to the clinical team and clients • Oversee current staff and new-hire training on technology, regulatory changes, and operational processes • Participate in developing education tools for staff and communicate expectations clearly • Ensure clients receive historical and current trend reports and communicate findings to clients, coding teams, and nursing teams • Coach, develop, and mentor clinical staff to achieve quality performance using servant leadership principles • Develop management skills to lead teams and handle operational challenges • Organize training for new and existing team members • Prepare, deliver, and assign client communications supporting audit findings • Maintain required certifications and continuing education requirements • Perform other duties as assigned • Support compliance requirements requested by business partners

🎯 Requirements

• Registered Nurse credentials preferred • Active coding certification, such as CCS, CPC, or CIC • Extensive experience in overseeing hospital bill audits, itemized bill reviews, and high dollar audits for facility inpatient and outpatient claims • Experience training others • Experience leading or managing a team • Strong knowledge of CPT, HCPCs, ICD-10, and Revenue codes • Strong knowledge of CMS and coding guidelines • Knowledge of IP and OP facility coding and billing guidelines • Policy development experience • Quality assurance experience • Experience with machine learning/artificial intelligence a plus • Clinical Documentation Improvement experience a plus • Encoder, Codify, TruCode/TruBridge, 3M, WebStrat, or similar experience a plus • Ability to work primarily in an indoor office environment around computers and printers • Ability to perform sedentary work, typing, and repetitive computer-related motions continuously throughout the day • Ability to concentrate on analytical tasks, read information, and communicate verbally and in writing continuously throughout the day • May be required to complete background and drug screenings and disclose personal health information or personally identifiable information

🏖️ Benefits

• Competitive salaries • Health insurance • 401(k) plan with employer match • Paid parental leave