CDM/Revenue Integrity Manager

at R1 RCM in Chicago, Illinois, United States

Job Description

R1 RCM Inc. is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals, and physician practices. Headquartered in Chicago, R1® is a publicly traded organization with employees throughout the US and international locations.

Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patients, and each other. With our proven and scalable operating model, we complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.

As our Revenue Integrity/CDM Manager you are responsible for overseeing all activities necessary to resolve healthcare claims that are either underpaid or overpaid according to contracted payment terms. This includes identifying claims that qualify for additional reimbursement under alternative methodologies to secure funds for high-cost outlier medical claims. Every day you are researching, analyzing, documenting, facilitating appeals, reconciling accounts, preparing trend analyses, and generating monthly management reports. The manager ensures the successful closure of underpaid or unpaid third-party payer accounts through assertive and timely appeal processes, contributing to optimal net revenue recovery.

To thrive in this role you must have experience with denial management, hospital and profee coding experience, and a coding certification. You must also have experience with Revenue Integrity.

Responsibilities

+ Design and implement processes, technologies, KPIs, reporting, and meeting structures to proactively identify variances to contracted rates or other payment agreements.

+ Create and implement a program incorporating existing and new technology for contract modeling, work listing/workflow, and reporting.

+ Create reports specific to individual practices, regions, and payers.

+ Collaborate with a variety of stakeholders, including practice-specific managed care/contracting resources or vendors, legal teams, revenue cycle operations teams, IT teams, and others to accomplish goals, share information, and make business decisions.

+ Support by producing context on underpayment rates, current issues, and qualitative information about the timeliness and responsiveness of payers to issues.

+ Support in payer/provider rep calls, including providing a holistic and complete summary of all contract variance issues, underpayment issues, and other issues as supported by the reporting, processes, and teams outlined above.

+ Manage relationships with relevant vendors and/or establish new relationships with vendors to support the goals of the team as needed.

+ Implement and maintain charge master update process for all practices, utilizing best practice methodology. Develop process to identify charges below fee schedules.

+ Investigate and identify root causes to effectively quantify and prioritize issues for resolution or escalation.

+ Effectively communicate by summarizing technical details into business impacts, creating clear messages for leadership to understand and assist with issue resolution as needed.

+ Participate in the design of an enterprise-wide contract variance and management strategy including advising on the best-in-class technology solutions, resources needed, and organizational structure.

+ Work high priority/urgent variances on an escalation basis.

+ Produce financial reporting to assist finance teams in estimating and incorporating the impact of variances as well as the impact of resolution of variance issues.

+ Design and implement continuous improvement methods including training, education, process changes, quality measures; establish and measure KPIs to ensure that progress is made towards goals.

+ Prepare for and support internal and external audits related to payment variances, providing necessary documentation and insights.

+ Develop and direct team to deliver training to avoid upstream issues that are causing downstream variances/impacts.

Qualifications

+ 5 years minimum in revenue integrity, contracts and underpayments

+ Certification in billing and coding represented by any of the following: RHIA, RHIT, RN, CPC, COC, CCS, CIC or CCS-P

+ Revenue cycle experience in a major health care organization.

+ Working knowledge of financial statements and ability to analyze financial information and determine financial impact of possible changes.

+ Excellent presentation skills and facilitation skills.

+ Strong knowledge of medical coding (must include both ICD-10 and CPT-4 coding)

+ Willingness to travel as needed (approx. 25%)

For this US-based position, the base pay range is $45,409.55 – $87,948.00 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

The healthcare system is always evolving – and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team – including offering a competitive benefits package. (http://go.r1rcm.com/benefits)

R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.

If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.

CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent (https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf)

To learn more, visit: R1RCM.com

Visit us on Facebook (https://www.facebook.com/R1RCM)

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation and workflow orchestration.

Headquartered near Salt Lake City, Utah, R1 employs over 29,000 people globally and is traded on the Nasdaq stock exchange under the symbol “RCM.”