Revenue Cycle Affiliate Lead

The vision of Clinical Health Network for Transformation (CHN) is to better fulfill the mission and promise of Planned Parenthood to bring high-quality, affordable care to every member of our communities. CHN is a collaboration between Planned Parenthood affiliates across the United States.
CHN is looking for individuals who are committed to supporting our shared goal of strengthening and enhancing our awareness and commitment to advancing the cause of health and race equity in our organization.
The Revenue Cycle Affiliate Lead is responsible for working with the Revenue Cycle team to monitor performance for assigned member affiliate and provide process improvement recommendations for the affiliate. The Revenue Cycle Affiliate Lead is familiar with data analytics, understands revenue cycle, payer reimbursement, fee schedules, payer contracts, patient access, and financial verification metrics, and is skilled at creating information-based narratives to guide and improve processes.  

Essential Functions

• Establishes strong partnership with assigned member affiliate that is built on transparency, professional knowledge and credibility, and a commitment to identifying ideas and actions that deliver the best patient experiences
• Develops expert level technical knowledge of revenue, patient access, and financial verification business processes at assigned affiliate
• Proactively share feedback on Epic build and workflow configurations, request changes for optimized workflows
• Manages annual external coding audit, reviews findings and works with affiliate clinical staff to incorporate into provider training
• Develop deep understanding and proactively manage workflows for affiliate work queues. Develop process workflows to ensure the teams are working efficiently
• Resolve accounts assigned to affiliate owned work queues within 14 days of work queue entry
• Manage payor contract document retention and use these contracts and fee schedules to assist the CHN RCM team with underpayment and overpayment analysis
• Act as a liaison between CHN and payor provider representatives building relationships to troubleshoot payor issues
• Review/Approve patient refunds and assist affiliate team to ensure refunds are sent to patients timely and in compliance with state regulations
• Assist revenue cycle teams with special projects as assigned by Revenue Cycle Manager
• Submit Jira tickets and track progress, communicate progress with Revenue Cycle Manager and affiliate
• Collaborates with affiliate on process improvement opportunities, specifically with the health center managers on front desk revenue cycle responsibilities. Facilitates the development and implementation of solutions
• Participates in affiliate business meetings where patient care and revenue opportunities are discussed
• Identify training gaps for front desk or provider staff members that can improve the RCM cycle
• Identify affiliate reporting needs and request ad hoc reports through the established CHN team
• Identify/trend revenue cycle issues and engage in problem solving activities when needed. Specifically bringing forward trends identified in front desk and provider workflows that impact the overall RCM cycle
• Ensures compliance with all CHN and affiliate policies, as well as all state and federal regulations
• Demonstrates a commitment to CHN and Planned Parenthood’s mission related to health equity, especially centering racial equity, and deep sense of accountability to community
• Demonstrates a commitment to learning about and enhancing practices related to racial equity and the impact of structural racism on healthcare systems
• Provides positive and development feedback and accountability related to practices including, but not limited to, equity

The above duties and responsibilities are not an exhaustive list of required responsibilities, duties, and skills. Other duties may be added, and this job description can be amended at any time

Qualifications and Experience (Required)

• Bachelor’s degree in a Health Care Management or Health Care Administration or a related field or 5+ years equivalent experience in lieu of education requirement 
• 3-5 years of experience in health care revenue cycle management and medical billing office setting, with a successful record of accomplishment of analyzing and reporting key performance indicators to management and/or leadership 
• Strong interpersonal skills and the ability to build relationships across organizational boundaries 
• Demonstrated experience in revenue cycle business analysis and communicating and presenting data and findings to Senior and/or Executive Leadership 
• Possess excellent working knowledge of all revenue cycle, patient access, and financial verification business process