The Mgr RC Contract Variance is a proactive member of an interdisciplinary team of licensed and unlicensed care givers who ensure that patients, families and significant others receive individualized high quality, safe patient care. It is expected that all RN Clinical Nurses - are licensed, knowledgeable and uphold the practice of nursing as outlined by the Georgia Professional Nurse Practice Act and implements the Scope of Practice and Code of Ethics Standards put forth by the American Nurses Association.
Schedule:Full Time
Shift: Day Shift
Level: 6+ years of experience
Success Profile Find out what it takes to succeed as a Mgr RC Contract Variance:
Collaborative
Time Efficient
Organized
Critical Thinker
Attention to Detail
Compassionate
Benefits that Reflect Your Contributions
Your Pay A compensation program designed for fair and equitable pay.
Your Future Secure your future with plans that also include an employer match. Plans and guidance for the future.
Your Wellness Traditional healthcare benefits combined with progressive wellness programs to help you be your best self!.
Your Joy Special and unique benefits and programs ensuring a balanced life and a workplace culture built on trust.
Job Details
Facility: WAB - Wellstar Administrative Building
Job Summary:
Under the direction of the Director of HB A/R Management, the Manager of Contract Variances coordinates all assigned HB Contract variance department activities including, but not limited to supervising, training, interviewing, hiring, counseling and terminating employees, as circumstances dictate. The Manager of Contracts Variance must provide the dynamic development of strategies for establishing a continuous improvement work environment, ensure eligible closed-balance accounts are reviewed, escalated, or closed within the designated payer time frames and are documented appropriately in the patient accounting system. The role requires extensive data analysis, trending analysis, project management, and departmental educational capabilities regarding payor and revenue cycle payment related processes. This role requires a versatile and well developed knowledge of billing, collections, contractual provision interpretation and understanding of provider / payor escalation requirements. In addition to a strong understanding and capability of common business technologies such as MS Office, Excel, PowerPoint, Word and Outlook to perform and communicate the assessment and analysis of multiple acute care and LTAC facility accounts receivable portfolios. The core role focus of this position is to ensure that closed-balance accounts are brought final resolution through reimbursement for services and to mitigate financial losses through solid operational execution, development and conformity to defined Policies and Procedures. The Manager must possess the ability to develop and document action plans for quick resource deployment and communicate timely with staff to understand the specific reasons for on going contractual variances. The role requires the ability to effectively and efficiently communicate both orally and in writing to Senior Leadership, multi-task, meet deadlines, enforce organizational policies and procedures, maintain high staff engagement, ensure staff productivity, appropriate cost controls and produce effective operational execution. In addition, the Manager will assist with additional Revenue Cycle related tasks and duties as assigned.
Core Responsibilities and Essential Functions:
Maintain a working knowledge of contractual language, processes and functions, responding appropriately to payor esclations, collection issues, hospital policies, and to insure current reimbursement on AR inventory. - Demonstrate effective departmental leadership, and provide direction to the staff in the performance of their daily functions by assisting with daily planning, organizing, prioritizing and management of operations, review closed claim accounts, evaluating trends, optimizing workflow and process to reduce contractual varainces, quickly creating action plans to reduce trends, resolving issues, etc. - Manage and supervise professional level staff, providing direction and guidance to the same, creating a team environment through training, recognition/evaluation, and in-service education which produces optimum work habits and job performance - Set obtainable strategic and short-term goals, maintaining expected level of staff productivity as well as conducting performance studies to improve productivity, streamline operations and reduce error rates. Provide assistance with staff training and oversight that newly implemented policies and procedures are being followed. Meet deadlines established through interaction with the Director of HB A/R Management or other senior leadership. - Review and improve work procedures to ensure that the most productive and efficient methods are used - Monitor progress for each area on a daily basis, utilizing quantitative productivity reports and providing feedback to staff - Provide assistance with departmental projects and presentations, as needed. - Maintain and reflect a positive team attitude, regarding any special projects or polices that are implemented by the Revenue Cycle or other senior leadership. - Must maintain a proficiency of, key automated systems that include: Epic, Nthrive woklist, etc. - Act as an internal resource; resolving problems and providing assistance to other hospital departments - Maintain Epic assigned workqueues to ensure timely (7 days, or as specified resolution of review requests - Ensure defined audits required of closed-balance accounts are completed accurately and submitted on time. Management and direction of human resources, job requirements, performance improvements, professional organizations, etc. - Assist with hiring, special recognition, disciplinary actions, promotions and transfers for the department as well as developing annual employee performance reviews including merit recommendations. Must be timely in interaction with staff related to any Human Resource activity to ensure timelines are met and communication is occurring. - Prepare departmental statistics regarding productivity, quality and performance measures. - Responsible for presenting monthly management and quarterly staff meetings. - Maintain a working knowledge of WellStar policies and procedures relating to employment, and of relevant state and federal regulations that address the employment and supervisory process. - Maintain membership and active participation in the HFMA professional organization, or equivalent, to participate in workshops and classes ensuring a competency level beneficial to the department, as well as to meet minimum requirements in technology advances/applications.payments, and/or system-related issues Must actively participate and support the efforts of the Revenue Cycle Task Force, as well as other committees as assigned. - Maintain ongoing communication with other PFS and Revenue Cycle departments, keeping the Director aware of more complex problems and opportunities while maintaining courteous, cooperative, flexible and positive working relationships with all levels of management, employees, physicians, guests and the general public. - Maintain a working knowledge of relevant legal and compliance issues, including but not limited to HIPAA privacy, Fair Debt Collection Act guidelines, Medicare Medicaid regulations, as well as state and federal laws. - Maintain effective communications with legal collection groups, the WellStar Compliance department and other agencies, regarding new and relevant issues must maintain appropriate knowledge and skill sets to read and interpret various regulatory requirements that affect follow-up functions. Maintain appropriate documentation to assure an audit trail of compliance-related activities. - Communicate with and obtain assistance from various type insurance, third party collection, governmental and regulatory agency representatives, in the interpretation of critical regulations and the collection/resolution of patient accounts. Direct the development, processes and efficiency of Contract Variance policies procedures to ensure they are comprehensive in nature, current and consistently updated. Consistent review of current processes to ensure compliance with policies and procedures. Establish controls and review mechanisms for every procedure to ensure that systems and procedures are being followed correctly Ensure optimal system capabilities by coordinating with vendors and IS, providing training, documentation system parameters, challenging systems and obtaining feedback from staff/users. Create, update, edit, revise and communicate necessary changes of said policies and procedures within the department as well as to other necessary areas within WellStar. Assist in the development, implementation and control of the Contract Variance budget, including determining cost and justifying staff requirements as they relate to the successful completion of all Contract Variance policies and procedures.
Required Minimum Education:
Bachelor's Degree in business, healthcare, related field Required
Required Minimum License(s) and Certification(s):
All certifications are required upon hire unless otherwise stated.
Additional License(s) and Certification(s):
Required Minimum Experience:
Minimum 10 years commiserate experience Required and Minimum 2 years experience in managing hospital patient financial services or related area. Required and Must have a thorough understanding of healthcare revenue cycle functions, PFS operations, Medicare and Medicaid regulations and reimbursement, project management, strong understanding of contractual language, collections, payment variance review, and performance improvement experience Required
Required Minimum Skills:
Establish a climate to achieve optimal performance levels and maintain a cohesive work team Demonstrate proficiency in reading UB04 Demonstrate proficiency in locating and interpreting contract verbiage for timely claims resolution Demonstrate proficiency in contract management and expected reimbursement technology Demonstrate knowledge of billing rules and coverage for all major payors Create and studies revenue reports/Key Performance Indicators and makes recommendations relative to revenue cycle processes for optimization Follow standard escalation process in established time frames Access Major payer(s) specific provider websites for claim investigation, correction and resolution path determination Work efficiently under pressure and deal effectively with constant change Operate a computer and related applications Apply appropriate supervisory, management and leadership techniques in an operational setting Work independently and take initiative Demonstrate a commitment to continuous learning Deal effectively with difficult people and/or difficult situation Willingly accept responsibility and/or delegate responsibility Set priorities and use good judgment for self and staff
Share the opportunity
Mission, Vision & Values At a time when the healthcare industry is changing rapidly, Wellstar remains committed to exceeding patients' and team members' expectations, while transforming healthcare delivery.
Our Mission To enhance the health and well-being of every person we serve.
Our Vision Deliver worldclass health care to every person, every time.
