Knowledge of CPT, HCPCs and ICD-10 coding principles.
Expert knowledge of inpatient and outpatient billing requirements (UB-04, 837i); specifically, how claims information impacts and drives reimbursement.
Expert knowledge of Medicare, Medicaid and Commercial reimbursement methodologies.
Intermediate to advanced proficiency in SQL or Database reporting queries.
Demonstrated analytical skills-ability to break down and quantify problems and processes.
Excellent written and verbal communication skills.
Demonstrated ability to manage a process and timelines effectively.
Nice to have
Master’s degree in accounting or finance, health information management, health administration, computer science, or related field.
Medical Coding Certification through the American Academy of Professional Coders (AAPC), and/or the American Health Information Management Association (AHIMA).
Revenue cycle supervisory or managerial experience.
Full description
Position Summary\:The Manager of Revenue Cycle Operations is responsible for the oversight of contract modeling, reimbursement analytics, contract management systems and payer performance analysis. This position leads in the development and implementation of best-practice processes that support accounts receivable valuation, reimbursement optimization, contract compliance and revenue cycle performance improvement. The Manager will collaborate closely with Revenue Cycle and Managed Care leadership to drive decision making, optimize contractual reimbursement and ensure operational excellence.
Duties including, but are not limited to\:
Manages and mentors contract management, Hospital’s Joint Operating Committee (JOC) and analytics staff.
Develops contract models to support payer contract negotiations.
Analyzes proposed contract amendments and payer policy changes to quantify financial impact.
Builds and maintains payer contracts in contract management systems.
Coordinates the team dedicated to ensuring reimbursement calculation accuracy.
Provides detailed reports to Managed Care department for topics including, but not limited to; systemic underpayment issues, accounts associated with payer policy disputes, contract rate modeling, CDM price change analysis compared to contract rates, etc.
Prepares data analysis for Revenue Cycle and Managed Care Contracting leadership which clearly conveys trends and identify key areas for revenue and contract optimization and operational performance improvement.
Monitors and tracks ongoing payer performance through key performance indicators (KPI) in comparison to industry benchmarks.
Directs the efforts of the JOC teams tasked with resolving contested accounts receivable and driving settlement.
Audits staff’s work and participate in developing and delivering training programs within the department.
Creates system and process audit plans. Resolves discrepancies, as required.
Troubleshoots issues and resolve concerns, as well as recommends necessary fixes. Advises management of results and recommend actions.
Creates reports to evaluate accounts receivables and business outcomes.
Cultivates effective collaborative relationships with departmental teams to seek resolution of payer contract and reimbursement issues.
Maintains expert knowledge of Medicare, Medicaid and Commercial reimbursement. Stays abreast of group payer contracts, payer policies, payer plans, and member benefits. Keeps apprised of rules and regulations affecting reimbursement.
Manager Revenue Cycle Operations at Stony Brook University (Multiple Locations) — aijobsearch
Manages special projects and duties as needed or assigned.
Leads the analysis implementation and maintenance of revenue cycle best practice processes and activities.
QualificationsRequired Qualifications\:
Bachelor’s Degree and 5 years' revenue cycle, reimbursement analytics, contract management or managed care experience.
Proficient in MS Office Suite including; Excel (Power Query; BI), Word, Access, Visio, and PowerPoint.
Knowledge of CPT, HCPCs and ICD-10 coding principles.
Expert knowledge of inpatient and outpatient billing requirements (UB-04, 837i); specifically, how claims information impacts and drives reimbursement.
Expert knowledge of Medicare, Medicaid and Commercial reimbursement methodologies.
Intermediate to advanced proficiency in SQL or Database reporting queries.
Demonstrated analytical skills-ability to break down and quantify problems and processes.
Excellent written and verbal communication skills.
Demonstrated ability to manage a process and timelines effectively.
Preferred Qualifications\:
Master’s degree in accounting or finance, health information management, health administration, computer science, or related field.
Medical Coding Certification through the American Academy of Professional Coders (AAPC), and/or the American Health Information Management Association (AHIMA).
Revenue cycle supervisory or managerial experience.
*Please Note\: Verification of degree (e.g., diploma or official transcript) is required for this role. Upload of documentation must be included with your application for consideration.
Special Notes\: Resume/CV should be included with the online application.
Posting Overview\: This position will remain posted until filled or for a maximum of 90 days. An initial review of all applicants will occur two weeks from the posting date. Candidates are advised on the application that for full consideration, applications must be received before the initial review date (which is within two weeks of the posting date).
If within the initial review no candidate was selected to fill the position posted, additional applications will be considered for the posted position; however, the posting will close once a finalist is identified, and at minimal, two weeks after the initial posting date. Please note, that if no candidate were identified and hired within 90 days from initial posting, the posting would close for review, and possibly reposted at a later date.
Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
All Hospital positions may be subject to changes in pass days and shifts as necessary.
This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
This function/position may be designated as “essential.” This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.
Prior to start date, the selected candidate must meet the following requirements\:
Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services.*
Complete electronic reference check with a minimum of three (3) professional references.
Successfully complete a 4 panel drug screen*
Meet Regulatory Requirements for pre employment screenings.
Provide a copy of any required New York State license(s)/certificate(s).
Failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.
*The hiring department will be responsible for any fee incurred for examination.
Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.
If you need a disability-related accommodation, please call the University Office of Equity and Access at (631)632-6280.
In accordance with the Title II Crime Awareness and Security Act a copy of our crime statistics can be viewed here.Visit our WHY WORK HERE page to learn about the total rewards we offer.Stony Brook University Hospital, consistent with our shared core values and our intent to achieve excellence, remains dedicated to supporting healthier and more resilient communities, both locally and globally.Anticipated Pay Range\:
The salary range for this position is listed below. This range reflects Stony Brook University Hospital’s good faith and reasonable estimate of potential compensation at the time of posting.
The final offer will be determined based on the candidate’s verified years of relevant, comparable experience. Please note that misrepresentation or inflation of experience may result in disqualification from the hiring process or termination of employment if hired.
Some positions may also include annual supplemental pay, such as\:
Location Pay\: for UUP full-time positions
Shift Differentials\: Additional pay for evening, night, or other supplemental shifts (e.g., inconvenience pay, geographic pay, or other applicable differentials)
At Stony Brook University Hospital, your compensation extends beyond your paycheck. We offer comprehensive benefits including generous leave, health insurance, and participation in the state pension system that contribute significantly to your overall total rewards package.