Senior Manager, Payment Resolution

HealthPartners is currently hiring for a Senior Manager, Payment Resolution. The Senior Manager is responsible for creating an efficient and effective payment resolution team that’s focused on the optimization of net revenue recovery. It leads and manages teams and processes that address technical denials, clinical denials, and underpayments. Additionally, the manager has oversight of all associated vendor partnerships.

Daily responsibilities for the Senior Manager include:

• Developing and controlling all activities necessary to accomplish project and department requirements, including building relationships with internal and external (vendors) throughout Health Partners. 
• Overseeing the programming of contracts into a contract management system and maintaining relationships with Managed Care payers to assist in the resolution of claims processing issues. 
• Reporting key metrics and outcomes to the Patient Financial Services leadership team and contributing technical expertise to the management team. 
• Extensive knowledge of managed care, governmental and third-party reimbursement structures, and regulations. 
• Collaborating across the organization to identify opportunities for workflow and process improvements, setting goals, measuring process effectiveness, ensuring productivity metrics achievements, and implementing policies and procedures. 
• Providing expertise to the organization related to payer reimbursement data and end-to-end revenue cycle claims processes.

The Senior Manager must be an involved leader, who can build trust and influence across a wide variety of stakeholder groups. Critical to this role’s success will be this leader’s ability to build relationships across all levels of individual contributors and leadership. This is a new position that has oversight of a Revenue Cycle Payment Resolution team comprised of a hospital centralized denial team, a post payment audit team, and a payment variance team. The Senior Manager will have up to five (5) direct reports with total accountability of sixty plus (60+) staff members. The team is comprised of payment variance specialists, clinical appeals nurses, payment resolution coders, denial specialists, and contract modeling analysts. The staff are responsible for contract modeling, validation, payer issues, and writing appeals and reconsiderations.

Required Qualifications:

• Bachelor’s degree in healthcare administration, finance, or related field.
• Ten (10) years of management experience within a hospital revenue cycle (e.g., denials management, collections, and reimbursement).
• Certified Revenue Cycle Representative (CRCR) certification within six (6) months of hire.
• Prior Epic hospital billing experience (e.g., Epic Resolute)

Preferred Qualifications:

• Hospital revenue cycle experience within a large/matrixed shared services environment.
• Experience within an acute care and critical access hospital revenue cycle setting.

Hours/Location:

• M-F; Days
• The Senior Manager may work remotely with occasional onsite needs.

Responsibilities:

• Leadership of Denial and Underpayment Operations (20%)
  • Direct and administer centralized denial and underpayment recovery operations. Managing centralized team of denial nurses, denial representatives, audit specialists, reimbursement staff and two managers.
  • Lead initiatives for optimizing payment resolution and aligning operations with organizational goals.
  • Facilitate denial management meetings to address denial trends across departments.
  • Participate in executive finance meetings monthly to review performance of revenue cycle metrics.
• Strategic Management of Payment Resolution (25%)
  • Develop and manage strategic initiatives for payment resolution areas, ensuring alignment with organizational objectives. Including the following areas:  technical denials, clinical denials, post payment audits and underpayment teams.
  • Interpret and implement complex rules and regulations to address insurance denials and underpayment trends.
  • Monitor and track performance metrics and key performance indicators (KPIs) to drive continuous improvements.
• Collaboration and Regulatory Compliance (5%)
  • Collaborate with leadership, medical staff, billing, coding, ut