Job Title: Revenue Recovery Manager

Company Overview

For more than 20 years, Cloudmed has been helping healthcare providers recover revenue and bolster their bottom lines. Cloudmed’ recovery methodology and technology platforms work to optimize the revenue cycle. With the use of intelligent proprietary analytics, our recovery teams are truly the best and most experienced at finding and recovering lost or unidentified revenue. We take a holistic approach to revenue recovery and look at not only contract compliance, but charge and revenue integrity, as well as regulatory compliance such as Transfer DRG and DRG validation. Today, we serve over 1,600 hospitals and health systems nationwide and are proud of numerous awards and recognitions, including being consistently named one of the Best Places to Work both locally and nationally.

Description

The Recovery Department Manager is responsible for the appropriate management of the department’s accounts, workloads and process as well as employee development, recruitment, client meetings and auditing. Responsibilities include initial reviews, employee training and development, process and case audits, management of the department supervisor(s) and Lead Reimbursement Analysts.

RESPONSIBILITIES

• This is not an inclusive list. Other duties may be assigned

• Assist in all training required to ensure reimbursement analysts resolve, call and/or appeal a defined number of accounts as instructed by leadership.
• Review, draft and/or approve complex and contractual appeals and letters to insurance companies.
• Ensure staff are appropriately educated on client contract language and rates as necessary to resolve denied claims.
• Ensure staff understand and can apply basic payment methodologies including but not limited to per diem, case rate, grouper and DRG payment methodologies as needed.
• Train staff to refer to and utilize payer provider and administrative manuals to dispute denied claims.
• Notate feedback given to staff members on individual claims in Quantum Appeals.
• Ensure that all expected payments are trolled weekly and posted to Quantum Appeals for invoicing.
• Audit case work and process.
• Engage in and develop employee training material.
• Develop new clients and assist in establishing new referral and case work protocol.
• Keep department director informed of any employee or department related issues, concerns or deficiencies.
• Complete and present performance appraisals to staff.
• Counsel staff as needed on process and case work.
• Approve cases eligible for clinical review through the use of the Medtrak tab.
• Approve and review cases for external appeal and outpatient billing.
• Assist with training of employees and provide necessary feedback as requested by management.
• Ensure all client status requests and inquiries are properly addressed by staff.
• Provide necessary employee feedback on Medtrak approvals, outpatient bill and/or re-bill requests, external appeals and payments.
• Complete initial reviews as assigned.
• Communicate all employee issues or potential areas with employee immediately and report any counseling sessions to the department director.
• Identify underperforming employees and recommend a performance improvement plan.
• Post received payments in Quantum Appeals and appropriate spreadsheets for accurate billing of clients.
• Maintain an understanding of how to utilize a multitude of hospital patient accounting systems (i.e.; Epic, Meditech, Eagle, and IDX) to accurately identify payments and retractions.
• Run and attend client status meetings.
• Oversee trolling department and ensure all provider systems are trolled on a weekly basis
• Monitor and ensure department reaches financial goals on a weekly basis.
• Meet all weekly performance standards and goals set by management.
• Manage daily workloads of Recovery Department staff and ensure the following:
  • Follow-ups are addressed promptly
    • Alerts must be addressed within a day of receipt.
    • Initial call requests must be addressed within two days from the receipt of the follow up.
    • Follow ups should never be more than 14 days old.
  • Ensure that assigned accounts are appealed timely through the use of Quantum Appeals worklist.
  • Ensure that all assigned cases have a follow up and that there are no duplicate follow ups.
  • Audit case weekly on employee worklists and via the case referral summary to ensure that staff is following up on all appeals, claims, letters or other documentation within 20 days of the submission.
  • Ensure that worklists are audited by the employee weekly through worklist prioritization and the open task report.
  • Ensure that all staff has the appropriate volume of work to ensure maximum output as defined by leadership.
  • Monitor to ensure that all RUSH cases are filed timely.
    • A RUSH is defined as an appeal or submission that is due within two weeks from the date of action or review.
  • Ensure staff is maintaining at least one follow up in all accounts assigned
• Enlist the assistance of Provider Representatives on an individual or batch case level to resolve complex claim and appeal issues.
• Audit and review client status reports to ensure the following:
  • Cases are closed
  • Aged cases have been appropriately escalated and/or recently reviewed to ensure prompt resolution
  • Ensure all initial reviews have been completed and are not aged more than 2 weeks from receipt
  • Ensure the proper status message and/or closure result is displayed
  • Monitor for any trends in stalls, placement volume or outstanding payments and report back to the department director
• Act as a department liaison to assist in process development across departments.
• Administrative duties or projects as assigned by leadership.
• Provide daily, weekly or monthly feedback as requested by leadership
• Report facility, payer and/or denials trends when discovered.
• Report and address any potential employee training needs.
• Manage and audit provider inventory and status reports as assigned.
• Assist in meeting report preparation and development.
• Follow all HIPAA guidelines

REQUIRED QUALIFICATIONS

Bachelor's degree from four-year college or university with at least three years related experience; or five to seven years related experience and/or training; or equivalent combination of education and experience.

CULTURE FIT

The culture at Cloudmed embraces those that demonstrate a deep passion for solving the problems of healthcare with enthusiasm for building positive working relationships and winning as a team. Take the work seriously, but don’t take yourself too seriously. Creating a strong workplace culture has been one of our staples, which we believe encourages and inspires employees to do their best. Join a fulfilling team of like-minded individuals who can get their work done, but still have fun!

BENEFITS

Cloudmed provides an extremely competitive benefit package that includes a 401(k) match, medical/dental/vision insurance and more.

Cloudmed is an Equal Opportunity Employer