Revenue Cycle Manager, (Adjustments & Payer Escalation)

Columbia University
United States, New York, New York
Dec 21, 2024
Job Type: Officer of Administration Regular/Temporary: Regular Hours Per Week: 35 Standard Work Schedule: 9AM-5PM, M-F Salary Range: $95,000.00-$110,000.00 The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to departmental budgets, qualifications, experience, education, licenses, specialty, and training. The above hiring range represents the University's good faith and reasonable estimate of the range of possible compensation at the time of posting. Position Summary The Revenue Cycle Manager is responsible for overseeing the adjustment and pay escalation functions within the Clinical Revenue Office. This role manages a team of Adjustment Supervisors, ensuring accurate resolution of payment discrepancies, adjustments, and escalations. The Manager collaborates with internal teams and external payers to maximize reimbursement, maintain compliance, and implement solutions that enhance revenue integrity. This role combines team leadership, operational oversight, and expertise in complex adjustment processes to drive performance and support the overall revenue cycle. Responsibilities Operations Management Oversee the daily operations of adjustment team and payer escalation processes, ensuring accurate identification and root cause analysis. Facilitate the escalation of unresolved payment discrepancies with payers and ensuring proper payment through bulk appeals and follow-ups. Develop and implement standardized workflows and procedures to enhance the efficiency and accuracy of adjustment and escalation processes. Manage the escalation of unresolved payment discrepancies with payers and ensuring proper payment through bulk appeals and follow-ups. Develop and implement standardized workflows and procedures to enhance the efficiency and accuracy of adjustment and escalation processes. Monitor work queues, validate adjustment entries, and oversee escalation actions to ensure compliance with established protocols and standards. Act as the primary escalation point for complex payment issues, coordinating with payers and internal departments to resolve discrepancies promptly. Analyze trends in pay escalations, identifying root causes and implementing solutions to prevent recurrence and improve financial outcomes. Oversee the bulk appeals process through escalated cases, ensuring that all necessary documentation is prepared and submitted to support payment corrections and recoveries. Collaborate with internal stakeholders, including billing, coding, and contracting teams, to ensure accurate interpretation of payer policies and facilitate resolutions. Track and report on the status of escalated claims, providing updates to senior management and stakeholders. Quality Assurance Reporting Ensure all adjustment and pay escalation activities comply with payer guidelines, institutional policies, and regulatory standards, including HIPAA and CMS guidelines. Execute quality audits of adjustment and escalation processes, implementing corrective actions to maintain compliance and enhance operational accuracy. Develop internal audit processes for adjustments and escalations, ensuring all actions are thoroughly documents and compliant with both internal policies and external regulations. Stay abreast with changes in payer policies, billing regulations, and industry standards, adapting procedures to ensure ongoing compliance and best practices. Prepare and present performance reports on adjustments and escalations to senior leadership, highlighting trends, issues, and recommendations. Conduct root cause analyses of recurring payer issues, making recommendations for process adjustments to prevent future occurrences. Process Improvement Lead initiatives to improve adjustment and escalation processes, leveraging data analysis and technology to enhance efficiency and reduce payment discrepancies. Identify opportunities for process optimization and develop solutions to drive improvements in adjustment accuracy and payer responsiveness. Provide insights and recommendations to senior management on solutions to mitigate payment discrepancies and enhance overall revenue cycle performance. People Manage and provide leadership to assigned staff including Adjustment Supervisors, guiding them in the day-to-day management of adjustment processes and payer escalations. Set performance standards and goals for supervisors and their teams, monitoring progress and providing coaching to achieve operational excellence. Conduct performance evaluations, provide feedback, and implement development plans to support professional growth and improve team performance. Lead regular team meetings to discuss trends, address challenges, share best practices, and ensure alignment with departmental goals. Collaborate with clinical departments, revenue cycle teams, and external payers to address adjustment and escalation challenges, ensuring effective and timely resolution of payment issues. Communicate clearly and effectively with internal and external stakeholders, providing guidance on complex cases and insights to improve payment integrity. Compliance & Other As a member of the management team, performs other tasks, assume additional management or supervisory responsibilities within the Revenue Cycle Department as assigned. Represents the FPO Clinical Revenue Office on cross-functional committees, task forces and work groups as assigned. Advocate for improvements in adjustment processes and payer escalation strategies in relevant meetings, task forces, and committees. Conforms to all applicable HIPAA, Billing Compliance and safety policies and guidelines. Please note: While this position is primarily remote, candidates must be in a Columbia University approved telework state. There may be occasional requirements to visit the office for meetings or other business needs. Travel and accommodation costs associated with these visits will be the responsibility of the employee and will not be reimbursed by the company. Minimum Qualifications Bachelor's degree in business administration, Health Services Administration, Finance, or a related field, or equivalent combination of education and experience. Minimum of 4 years of experience in revenue cycle management, adjustments, or reimbursement, with a strong focus on payer escalations and appeals. An equivalent combination of education and experience may be considered. In-depth knowledge of payer guidelines, billing regulations, and healthcare finance, particularly in the context of adjustments and payment discrepancies. Proven ability to manage complex cases, analyze data, and implement solutions to enhance financial outcomes. Strong analytical, problem-solving, and decision-making skills, with excellent attention to detail. Excellent communication and negotiation skills, with the ability to interact effectively with internal teams and external payers. Proficiency in Microsoft Office (Word, Excel) and experience with billing and adjustment software, including EPIC and GE/IDX systems. Must successfully complete required trainings. Preferred Qualifications Experience working in a large healthcare system, central billing office, or academic medical center. Familiarity with payer contract management and revenue integrity practices. Advanced proficiency in data analysis tools and experience generating reports and presentations for management. Competencies Patient Facing Competencies Minimum Proficiency Level Accountability & Self-Management Level 3 - Intermediate Adaptability to Change & Learning Agility Level 3 - Intermediate Communication Level 3 - Intermediate Customer Service & Patient Centered Level 3 - Intermediate Emotional Intelligence Level 3 - Intermediate Problem Solving & Decision Making Level 3 - Intermediate Productivity & Time Management Level 3 - Intermediate Teamwork & Collaboration Level 3 - Intermediate Quality, Patient & Workplace Safety Level 3 - Intermediate Leadership Competencies Minimum Proficiency Level Business Acumen & Vision Driver Level 1 - Introductory Performance Management Level 2 - Basic Innovation & Organizational Development Level 1 - Introductory Equal Opportunity Employer / Disability / Veteran Columbia University is committed to the hiring of qualified local residents.