Manager, Revenue Recovery Unit

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.

Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary:

Assists in the development and implementation of best practices, policies and procedures within the enterprise operations of underpayment identification and recoveries. Establishes and fosters the timely follow-up of third-party underpayments from third-party payers, inclusive of government, commercial and HMO's. Establishes and monitors productivity and quality standards accordingly to industry benchmarks. Coordinates with supervisors to implement weekly/monthly performance standards, as well as continuous training and development. Facilitates the aggregation of payer issues and themes for shared feedback throughout the revenue cycle continuum. Coordinates with revenue recovery unit leaders to analyze internal process and workflows to identify bottlenecks, redundancies, and areas for optimization in the recovery of identified underpayments. Promotes a culture of continuous learning and innovation, identifying refinements and enhancements which drive performance. Spearheads projects which have the potential to increase net revenue collections and provide valuable insights to partners (e.g., patient access, coding, revenue integrity, patient financial services, care management, finance). Manages supervisors and staff in the timely identification of underpayment pursuits, compliant billing and follow-up, appeals/reconsiderations for acute and ambulatory services. Establishes and monitors key performance metrics to track enterprise and network performance and cost efficiencies. Reviews inpatient and outpatient claims to ensure maximum collection dollars by providing appropriate follow-up and documenting actions taken.

Job Requirements:

Education and Work Experience:

• Bachelor's Degree or equivalent combination of education/related experience: Required
• Master's Degree: Preferred
• Five years' technical experience: Preferred
• One year leadership experience: Preferred

Essential Functions:

• Establishes and facilitates departmental priorities and workflow objectives to identify and pursue underpaid government (Medicare, Medi-Cal), commercial and managed care claims related to hospital and professional claims. Analyzes internal process and workflows to identify bottlenecks, redundancies, and areas for optimization in the recovery of identified underpayments. Promotes a culture of continuous learning and innovation, identifying refinements and enhancements which drive performance. Spearheads projects which have the potential to increase net revenue collections and provide valuable insights to partners (e.g., patient access, coding, revenue integrity, patient financial services, care management, and finance). Monitors and coordinates with third party vendors as directed by the revenue recovery unit leadership.
• Manages supervisors and staff in the timely identification of underpayment pursuits, compliant billing and follow-up, appeals/reconsiderations for acute and ambulatory services. Establishes and monitors key performance metrics to track enterprise and network performance and cost efficiencies. Reviews inpatient and outpatient claims to ensure maximum collection dollars by providing appropriate follow-up and documenting actions taken.
• Facilitates consistent use of technology (e.g.,Cerner, EPIC or bolt on contract management system) to efficiently identify potential underpayments, conduct quality review and when appropriate pursue variance with third party payers. Monitors metrics and reports to ensure departmental, team and individual staff production goals are consistently achieved. Monitors and adjusts inventory as necessary to ensure timely follow-up and balanced workloads.
• Develops and maintains departmental policies, procedures, and job aides to support protocols and compliance with governmental regulations, billing requirements and fundamentals of reimbursement practices. Trains supervisors, leads, and / or other staff as appropriate on business process, use of technology, complex reimbursement methodologies (e.g., stop loss, carve outs, limiting language) patient financial services units on revenue cycle systems, processes and procedures. Ensures supervisor and staff portfolio assignments remain aligned with production objectives. Analyzes complex financial data; Identify trends in revenue cycle operations. Summarizes data and presents reports to leadership and/or other st