Sys Dir Revenue Cycle Clinical Appeals

Job Description Location: Chicago, Illinois Business Unit: Rush Medical Center Hospital: Rush University Medical Center Department: Patient Financial Services Work Type: Full Time (Total FTE between 0.9 and 1.0) Shift: Shift 1 Work Schedule: 8 Hr (8:00:00 AM - 4:30:00 PM) Rush offers exceptional rewards and benefits learn more at our Rush benefits page ( Pay Range: $63.10 - $106.01 per hour Rush salaries are determined by many factors including, but not limited to, education, job‑related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rush’s anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case. Summary Under the leadership of the System Associate Vice President, Patient Financial Services, the System Director, Revenue Cycle Clinical Appeals oversees processes and functions associated with denials that require clinical review related to IP, OP, PB. Coordinate submission of Level 1, Level 2 and/or Level 3 appeals, and support for coding review and related follow-up. The system review processing includes the management for RUMC, ROPH, RCMC, Castle Surgicenter, including legacy service area locations and various privately contracted bundled services. In this role, the System Director, Revenue Cycle Clinical Appeals ensures effective system operations, participates in strategic planning initiatives, drives the implementation of plans, and oversees daily workflows for specific functional duties and areas of responsibility. The individual who holds this position exemplifies the Rush mission, vision and values and acts in accordance with Rush policies and procedures. Required Job Qualifications Bachelor’s degree and 7yr experience in financial analysis, patient finance, or consulting in a managerial position. 5+ years in Revenue Cycle leadership or supervisory experience. Strong knowledge of hospital and physician billing practices and insurance follow-up/denial workflows. Excellent verbal and written communication skills due to direct interaction with senior management. Strong time management and organizational skills. Strong problem solving and financial analytical skills. Ability to interact professionally with all levels of employees. Improves technical skills through professional development efforts. Preferred Job Qualifications Professional certification (CPA, HFMA, Epic system or similar) and/or Master’s degree (Business Administration, Health Systems Administration, or similar). Epic proficiency or certification License- Registered Nurse Certifications- Coding RHIT Strong knowledge of payer rules, regulations, along with the ability to analyze all forms of payments for accuracy. Physical Demands Sedentary Work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Competencies Experience in a large, multi-specialty hospital facility environment. Knowledge of Hospital/Physician billing experience in a complex academic setting. Knowledge of hospital Medicare, Medicaid and Commercial insurance regulations, specifically for underpayment and denial resolution purposes. Understanding of insurance and CPT/ICD coding. Ability to interpret contracts and governmental regulations. Disclaimer The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements. Responsibilities Supports strategic planning initiatives and participates in effective execution of planning relevant to functional area(s). In collaboration with the System AVP, Patient Financial Services, establishes benchmarks and performance metrics for functional areas of responsibility. Monitors functional area performance in connection with these metrics and Revenue Cycle overall performance, proactively identifying opportunities for improvement and communicating these opportunities with appropriate leadership/areas. Collaborates with other Revenue Cycle leaders on relevant activities and ensures interdependencies between specific area of functional oversight and other areas within Revenue Cycle have appropriate hand-offs. Proactively communicates to achieve seamless workflows and achievement of overall Revenue Cycle objectives. Participates in developing, implementing, and maintaining functional specific administrative and operating policies and procedures ensuring consistency within other areas of Revenue Cycle. Leverages technology to ensure that automated solutions and applications (Epic and non-Epic) support functional objectives. Identifies gaps and proposes solutions where necessary. Identifies, develops, and maintains reporting tools vital to sound management over the functional area(s) of responsibility. Effectively manages a departmental budget for functional area(s) of responsibility. Recruits for and guides the activities of direct reports ensuring optimization of human capital. Ensures the quality and accuracy of staff’s and overall department’s work Drives employee developmental programming including annual performance evaluation, employee engagement, and talent management. Consistently promotes and supports a team approach to innovation in programs and problem solving both within functional area of responsibility and in collaboration with other revenue cycle and non-revenue cycle stakeholder departments. Develops and maintains effective working relationships with vendors and peer managers both internal and external to the organization. Stays abreast of industry changes impacting functional area and Revenue Cycle and identifies potential impact and required changes. Strives to promote best practices within functional area and within Revenue Cycle. Ensures adherence to state and federal regulatory statutes as it pertains to functional area. Adheres to and supports Revenue Cycle departmental administrative policies. Functional Specific Duties and Responsibilities Primary roles and responsibilities collectively are comprised of HB & PB Clinical review of denials within the Revenue Cycle. Specific managerial oversight includes: Denial Management Bundled Episodes Complex Claims Processing Consider adding - DRG appeals, Clinical Validation reviews and Post Pay audits. Collector/ Customer service requested audits. Regulatory appeals i.e., Medicaid RAC audits. Managing accounts receivable balances. Partner with service lines and front-line Utilization Management teams to provide feedback. Understanding payer contracts, clinical criteria sets and interpreting payer medical policies. Developing and maintaining tools to track denials, and recoveries to affect process change. Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics. Position Sys Dir Revenue Cycle Clinical Appeals Location US:IL:Chicago Req ID 26614 #J-18808-Ljbffr