Commercial Managed Care Collections and Denials Manager - HB Patient Financial Services - FT Days

Who We Are UCI Health is one of California's largest academic health systems and the clinical enterprise of the University of California, Irvine. Established on July 1, 1976, UCI Health has grown into a 1,461-bed health system that includes UCI Health - Orange, UCI Health - Irvine, four Community Network hospitals and a growing network of ambulatory care centers across Orange and Los Angeles counties. As Orange County's only academic health systems, UCI Health is home to the only National Cancer Institute-designated comprehensive cancer center based in the county, the region's only American College of Surgeons-verified Level I adult and Level II pediatric trauma center, American College of Emergency Physicians Gold Level 1 Geriatric Emergency Department and a nationally recognized regional burn center verified by the American Burn Association. Powered by UC Irvine, UCI Health serves 5.6 million people across Orange County, western Riverside County and southeast Los Angeles County through excellence in patient care, research and medical education. Your Role on the Team The Commercial/Managed Care Collections/Denials Manager reports to the Assistant Director-Patient Financial Services and is responsible for managing hospital accounts receivables (A/R) and the collections, denial, and workflow activities for Commercial/Managed Care payers - Commercial, Managed Care, Workers Compensation, TriWest/VA and all other third-party payers. The incumbent manages daily operations certifying timely accurate account evaluation, escalation, and resolution ensuring compliance with procedures, standards, and policies as well as regulatory requirements. This role is responsible for training, managing work performance, A/R analysis, resolution of operational and personnel issues, evaluations, hiring, and corrective actions as needed. Presents as a key liaison between PFS and various departments leaders within the organization to identify and resolve issues relating to charges, coding, appropriate modifiers, and claim adjudication to yield first pass clean billing and enhanced revenue recoveries. Also responsible for performing routine analysis of various key performance indicators, dashboards, and reports to optimize performance and maintain positive A/R disposition. Reason, Comments, and Special Instructions: Updating the job description for the HB Patient Financial Services Patient Billing and Collection Supervisor 2 (JC 004669). What It Takes to be Successful Required Qualifications: Thorough knowledge of medical and insurance terminology, and of billing and / or collections internal procedures and external regulations. Strong time management and organization skills Strong technical knowledge of CPT, HCPS and ICD-10 coding, LCD, NCD, MUE, CCI, Modifiers, authorization requirements and related documentation Strong interpersonal and communication skills to collaborate and effectively manage conflict with all constituent groups Strong analytical and report writing skills to effectively comprehend multiple reports and analyze array into actionable form Strong ability to facilitate accurate and timely billing and collections Solid, demonstrated leadership skills to coach, mentor, and strengthen the team's performance Solid knowledge of human resources management policies, with the ability to evaluate and document human resources matters and performance. Solid critical thinking and decision-making skills, with the ability to analyze and evaluate complex and/or difficult problems, determine appropriate level of intervention, and develop and apply viable solutions Proficient in Microsoft Office and related programs (i.e. Microsoft, Excel, Outlook, PowerPoint, etc.) Must possess the skill, knowledge and ability essential to the successful performance of assigned duties Must have the ability to maintain a pace appropriate to the workload Minimum of three (3) years of experience in billing and collections of Commercial, Managed Care, Medicare, Medicare Advantage, Medi-Cal, CalOptima, FQHC, and CCS and other programs that fall under the scope of Government programs and commercial billing Minimum of five (5) years of related relevant experience in business office operations, consulting, or auditing Excellent verbal and written English communication skills including the ability to convey complex information in a clear, concise manner Demonstrated lead/supervisory skills to effectively oversee and prioritize staff activities and manage complex workflow and multiple priorities associated with billing and/or collections operations Demonstrated ability to use sound judgment Bachelor's Degree in related area and/or equivalent education/experience Ability to function independently and as a member of a team Preferred Qualifications: Prior experience with and working knowledge of EPIC electronic health record Total Rewards We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits. Conditions of Employment: The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment: Background Check and Live Scan Employment Misconduct* Legal Right to Work in the United States Vaccination Policies Smoking and Tobacco Policy Drug Free Environment Exercise the utmost discretion in managing sensitive information learned in the course of performing their duties. Sensitive information includes but is not limited to employee and student records, health and patient records, financial data, strategic plans, proprietary information, and any other sensitive or non-public information learned during the course and scope of employment. Understands that sensitive information should be shared on a limited basis and actively takes steps to limit access to sensitive information to individuals who have legitimate business need to know. Ensure that sensitive information is properly safeguarded. Follow all organizational policies and laws on data protection and privacy. This includes secure handling of physical and digital records and proper usage of IT systems to prevent data leaks. The unauthorized or improper disclosure of confidential work-related information obtained from any source on any work-related matter is a violation of these expectations. *Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer. The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements. California Child Abuse and Neglect Reporting Act E-Verify Pre-Placement Health Evaluation Details of each policy may be reviewed by visiting the following page: Closing Statement: The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC Anti-Discrimination Policy. We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming. UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI's Employee Experience Center (EEC) at View email address on click.appcast.io or at View phone number on click.appcast.io, Monday - Friday from 8:30 a.m. - 5:00 p.m. Consideration for Work Authorization Sponsorship Must be able to provide proof of work authorization #J-18808-Ljbffr University of California - Irvine Health