CCMC Denials, Payment Review & Transplant Manager (Manager, Patient Business Services)

Department Overview

Leads, directs, and implements operational tactics for the CCMC Denials, Payment Review, and Transplant units, driving efficient revenue cycle management across denial resolution, payment review, and transplant billing/follow-up—including specialized cellular gene therapy—for OHSU and all current/future system partners; CCMC encompasses Commercial, Contract, and Managed Care accounts.

Function/Duties of Position

Direct Management and Supervision

• Oversees the OHSU Health CCMC Denials, Payment Review, and Transplant units, ensuring seamless operations and high performance across all functions.
• Monitors follow-up worklists and develops action plans to achieve weekly billing and follow-up work-in-progress (WIP) goals.
• Provides strategic leadership to guide departmental operations effectively.
• Establishes goals and objectives to foster a collaborative, high-performing, and supportive team environment.
• Recruits, motivates, and coaches staff to drive exceptional performance and professional growth.
• Ensures staff are equipped with adequate training, resources, and information to execute their responsibilities.
• Resolves issues related to personnel, patient accounts, and organizational priorities, exercising sound judgment.
• Maximizes use of Aeos and Aeos Analytics to optimize unit performance and outcomes.
• Completes all tasks on the manager checklist (daily, weekly, monthly) to maintain operational rigor.
• Ensures all CCMC Denial, Payment Review, and Transplant account representatives adhere to standardized response guidelines, including defined pend times, to ensure consistency and efficiency.

Administrative Leadership

• Provides strategic direction for the OHSU Health CCMC Denials, Payment Review, and Transplant units to ensure efficient revenue cycle operations.
• Routinely monitors and reports on unit performance against established targets, ensuring transparency and accountability.
• Achieves standard performance metrics or develops targeted action plans to meet benchmarks effectively.
• Develops and maintains comprehensive department policies and procedures to support operational consistency, compliance, and excellence.

Operational Oversight and Optimization

• Supports the OHSU Health CCMC Denials, Payment Review, and Transplant units by driving operational excellence and efficiency.
• Monitors department activities, identifying issues and recommending solutions to resolve problems and prevent recurrence.
• Reviews and refines procedures to enhance efficiency, minimize billing delays, and expedite account resolution.
• Analyzes and reports on operational trends to inform strategic improvements.
• Collaborates across teams to optimize workflows, streamline billing processes, and improve individual and overall accounts receivable performance.
• Communicates effectively with all Patient Business Services (PBS) staff to provide support and ensure high-quality service delivery.
• Presents complex information clearly and tailored to diverse audiences, including staff, management, and external stakeholders.

Support for Internal Stakeholders

• Delivers high-quality assistance to PBS internal customers, including Patient Access Services (PAS), Managed Care Contracting, Professional Billing (PB), and Healthcare Financial Services (HFS).
• Leverages key staff expertise to ensure all information provided by PBS is accurate, complete, and responsive to stakeholder needs.

Other duties as assigned.

Required Qualifications

• Bachelor’s degree in healthcare administration, business, or related field.
• 5 Years of progressive supervisory experience to include recruitment, termination, and discipline of personnel.
• 5 years of hospital billing management and automated systems experience.
• 3 years of current Medicare and Medicaid program knowledge and experience (within the last 3 years).
• Comprehensive knowledge of payor networks, requirements, and reimbursement methodologies, including APCs, DRGs, CPT, HCPCS, ICD-10 coding, and modifiers.
• Strong leadership skills to foster team development, consensus-building, and effective supervision of multiple staff and priorities in a complex environment.
• Exceptional verbal and written communication skills to convey complex information to diverse audiences.
• In-depth understanding of healthcare industry financial and statistical indicators.
• Working knowledge of clinical and coding aspects of the revenue cycle, including Charge Description Master (CDM), or ability to quickly learn these concepts.
• Strong