Manager Process Improvement & Analytics

New Haven, CT
Oct 4, 2018

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Job Description

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
EEO/AA/Disability/Veteran
Summary:
Reporting to the Director, Revenue Management, this key role will provide direction; organizational planning and operational leadership related to revenue cycle management (RCM) initiatives across the System. This position will provide leadership and hands-on support for data mining, abstraction, prediction and analysis used to drive enhanced understanding of our population''s health, operational improvement, and a deep knowledge of our payer contracts to identify the potential and likely impacts on reimbursement across the health system. This position will seek to optimize revenue.

This position is responsible for the development and execution of a cycle mitigation and improvement program on a System-wide basis that monitors and provides substantive corrective action to effectively enhance revenue opportunities, and our understanding of patient trends and outcomes. This initiative should include the development of a collaborative relationship with counterparts in the CBS, IT, and others.

This position is also responsible for assisting in the development of new opportunities for revenue enhancement within the confines of the overall RCM system-wide initiatives. Leads multi-disciplinary work groups (Reimbursement, Budget and Planning and CBS) on projects associated with RCM reporting and initiatives with this overall goal of the identification of key areas of revenue and RCM growth opportunities. Assures the accuracy and accountability of reported revenue cycle information.
Responsibilities:
  • 1. Consistently demonstrating a deep knowledge of finance and accounting concepts, statistical methods, information technology (both unique to YNHHS and related to available technology), and our operational processes, and ability to communicate and document this knowledge in a way that can be understood.
  • 2. Manages and oversees all projects and staff associated with system-wide revenue cycle reporting functions and initiatives by identifying strategic areas for realization of incremental revenue, and reporting on these projects to leadership and other stakeholders with visuals and language that is easily understood. These projects include:
  • 2.1 Building and reviewing models and analytics, using modern statistical and other processing methods (distributed processing, least squares and logistic regression, iterative processes (machine learning), sensitivity analysis etc.) that can parse the over 15 million patient encounters documented in the health system''s EHR and other large data sources, to identify trends that are historically predictive of future outcomes, both for patient health and YNHHS financial results.
  • 2.2 Identifying and proposing modifications to payer contracts, including carve out rates, changes in hierarchy rankings, groupers, charge master, fee schedules, and pay for performance incentives that aim to increase managed care cash flows, with appropriate risk weighting, and create achievable financial incentives that align our interests with our patients. Effectively, attempting to maximize volatility adjusted returns from payer relationships, while keeping our financial incentives aligned with our clinical mission. This would provide stability in the monthly cash flows for the health system.
  • 2.3 Identifying comparable departments and comparing operations, including procedure choices (considering patient outcomes, reimbursement, and cost), to ensure that the most effective and efficient practices are shared across the health system. The Manager will develop a framework and method for helping clinical leaders identify discrepancies in practice and aid the conversation to standardize to the result to the one that provides the most value to our patients and the system.
  • 2.4 Creating and systematizing a set of key performance indicators based on the volumes of patient demographic billing data to predict cash flows in coming months that are proven to be historically predictive across the system.
  • 2.5 Reviewing acceptable coding methodologies that maximize payer reimbursement. In some of our payer agreements fewer views or lower level codes are reimbursed at a higher dollar value. The Senior Manager has and will identify opportunities where this exists.
  • 2.6 Leading market analysis using Center for Disease Control data and location based data about our patients to identify areas where targeted public health initiatives would have maximum impact.
  • 2.7 Implementing and monitoring a charging methodology that seeks to minimize our gross charges to patients, and aims to reduce the percentage of patient revenue that is paid by patients and maximize patient revenues paid by insurance carriers and governmental payers. This is better for our patients, and for the health system because institutions are more timely and reliable payers.
  • 2.8 Quantifying correlations between certain visit types, documentation, and diagnoses to identify and quantify the likelihood of full payment on individual claims, and establishing monitoring protocols to identify when payers depart from these trends. The Senior Manager will also share this information, so others in the system are aware of the impacts on likelihood of full payment when documenting procedures and diagnoses.
  • 2.9 Advising on EPIC build changes that will identify missing charges and accounts for review, while seeking to minimize unnecessary manual intervention and implementation time.
  • 2.10 Leading, understanding, and documenting highly quantitative compliance requirements, including cost and market impact reviews associated with acquisitions and other affiliations.
  • 2.11 Creating process documentation and controls that identify, quantify, and efficiently and effectively mitigate risks in the revenue process, including the risk of missing or inaccurate charges.
  • 3. Establish and cultivate a collaborative relationship with key stakeholders in information technology, billing, coding, accounting, and other areas of finance to communicate specific RCM goals and targets; working well with others to ensure key productivity metrics and budgeted revenue targets are achieved.
  • 4. Collaborate with YNHH Contracting to enhance our understanding of trends with certain payers, including the relative health of the population the payer represents, denial trends, and areas of risk in individual payer contracts to help realize maximum value from each payer relationship.
  • 5. Establish a strong, working relationship with CBS to establish an effective claims initiative that include the development and implementation of consistent financial policies that are effective in helping to achieve established revenue targets and maximize the overall system-wide revenue opportunities.
  • 6. Responsible for assisting in leading multi-disciplinary work groups consisting of key financial partners from Operations, Reimbursement, Budget and Planning and CBS on projects associated with the revenue cycle reporting process. These work groups are an integral component in identifying key areas of revenue growth opportunities on a system-wide basis.
  • 7. Effectively manage the charge capture process and develop and implement systems to ensure that all charges are captured.
  • 8. Ensure that there is an effective underpayment/non-payment review protocol, including a comprehensive method and reporting protocol to ensure the recovery of all charges.
  • 9. Implement and effectively monitor a dynamic work queue process to ensure that all claims are addressed and cleared in a timely manner.
  • 10. Manages the work of staff, including the selection, training and performance evaluation of staff.
  • 11. Ability to manage numerous projects simultaneously.

  • EDUCATION:
    B.A. or B.S. in Accounting and or Finance or related field is required. Master''s degree or CPA in relevant field preferred.

    EXPERIENCE:
    Five (5) to Seven (7) years'' experience in health care finance, database management, accounting, finance, public or other accounting, auditing, budget, compliance, billing or insurance required with progressive responsibility in accountability, leadership, supervision, and project management. Previous management experience preferred.

    SPECIAL_SKILLS:
    Demonstrated ability to function in, and relate to, diverse healthcare settings;
    Demonstrated understanding of contracts, clauses, codes, and modeling methodologies;
    Experience in assessing operational problems and performing sophisticated data analysis;
    Demonstrated ability to design and operate complex computerized tools and systems;
    Proven ability to communicate complex data and issues to a wide range of clinical, technical, administrative, and service personnel in a positive and educational manner;
    Experience managing cross sectional teams of individuals with diverse backgrounds and abilities.
    Demonstrated ability to develop systemic data and reporting tools extending the capabilities of the decision making options for the organization
    Ability to influence and direct the thinking of others and deal with all levels of management and different types of staff.

    ACCOUNTABILITY:
    Responsible for the management of System-wide projects related to Revenue Cycle Management. This function contributes directly to annual revenue performance, revenue enhancement goals. Enhances the accuracy of the underlying information as required and determined. Investigates problems and makes recommendations to senior management for future projects related to revenue enhancement. Manages the work of professional staff. Manages the project work plan for RCM on a system-wide basis. Manages the selection, training and performance evaluation of staff.

    COMPLEXITY:
    Serves as a technical expert on RCM issues, Contracts, Charge master, Fee Schedules, Analytics, Models Information Technology, and Forecasting. Manages and directs multi-disciplinary efforts for complicated revenue projects and development. Exercises independent judgment and discretion in the performance of duties. Manages project priorities, staffing assignments and financial valuations of opportunities. Acts as a resource and coordinator for corporate finance matters and supports the related information systems functions. *CB
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    Job Info

    Job: 2231

    Department: Revenue Management
    Category: Mgmt/leadership
    Status: Full Time
    Shift: DAYS
    Hours: 40.00