Manager, Itemized Bill Review

ABOUT PERFORMANT:

At Performant, we’re focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most – quality of care and healthier lives for all.

If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture – then Performant is the place for you!

ABOUT THE OPPORTUNITY:

Hiring Range: $95,000 - $115,000

The Itemized Bill Review Manager is a key member of the medical review audit group and supports building a world class healthcare services organization. The leader in this role directs the timely delivery of high-quality Itemized Bill Review (IBR) audits for our business, ensuring organizational goals are met.  This position may provide direct oversight of multiple departments and individual contributors, including Nurse Auditors and Coding Auditors.  As such, the qualified individual for this role will be a “Nurse Coder”, holding an active RN license and Coding certification(s) in addition to having experience with IBR (also known as hospital bill pay review) audits.
 

Key Responsibilities to include:

• Performs, Develops and executes on itemized bill review (IBR) plans, in accordance with internal audit standards and relevant statement of work.

• Prepares reports and manages IBR activities for assigned clients.

• Applies in depth level of expertise in performing IBR audits and development of policies and procedures and workflows processes to review claims, and identify processing, procedural, systemic and billing errors and practices leading to claims inaccuracies; also applies in-depth expertise in both outpatient and inpatient medical coding to the development of policies, procedures, guidelines, coding issues/refining coding parameters, workflow and tools.

• Manages team members performing IBR activities to identify trends, determine root cause of payment inaccuracies, and to recommend process and systems improvements.

• Proactively identifies opportunities for process improvement, efficiency, resolving problems, preparing and completing action plans. 

• Manages and trains team leaders and staff.  Supports staff recruitment, develops auditors and builds effective teams.

• Supports subcontractor communication, oversight and reporting. 

• Establishes accountability for performance monitoring (productivity/quality), communicates job expectations, trends, documentation, and ensures timelines are met.

• Supports strategy by conducting needs assessments, capacity planning, cost/benefit analyses, preparing staffing models, establishing productivity and quality standards.

• Maintains professional and technical knowledge by tracking emerging trends in IBR management; this may include attending educational workshops, reviewing professional publications, establishing personal networks, benchmarking state-of-the-art practices and participating in professional societies.

• Develops effective relationships with leaders in the organization and has a strong understanding of the business.

• Applies in-depth understanding of the inter-relationships of the business and support units throughout the organization.

• Accomplishes organizational goals by accepting ownership of requests; exploring opportunities to add value.

• Participates in business initiatives and pro-actively advises and assists the business on initiatives.

• Builds value and credibility with internal and external clients and represents the organization in meetings with the client, provider organizations, contractors, subcontractors and vendors.

• Uses excellent communication skills to influence a wide range of internal and external audiences.

• Provides timely response to escalated inquiries from the client and providers.

• Supports other departments in problem resolution as necessary.

• Completes required reports and ad hoc requests for information.

• Inspires trust and credibility; delivers on commitments; acts as IBR subject matter expert. 

• Facilitates meetings as necessary.

• Performs other duties as assigned.

Knowledge, Skills and Abilities Needed:

• Possess a broad and comprehensive understanding of IBR sta