Revenue Cycle Management, Director Credentialing, Contract Management, Payer Relations, Urology Partners of America, San Diego, CA

Posted on April 20th, 2022

POSITION SUMMARY:

Working directly with the Revenue Cycle Management, Vice President, the individual in this position is a key member of the RCM Leadership team, and is responsible managing the following areas: credentialing, contract management, payer relations.  This individual will also be required to become an expert, hands-on user/trainer of the practice management and credentialing systems, to develop comprehensive written workflows, guidelines, and policies and procedures to ensure effective management of provider data, credentialing, contract performance, and payer relations.

This position requires a mature and flexible individual who can deal with a wide range of personalities and responsibilities. The individual needs to be highly organized and motivated. This position also requires the individual to be able to prioritize the workload while working independently and to have the initiative to think problems through and seek assistance when needed. The job holder must demonstrate current competencies applicable to this job description.

Employees are required to adhere to all Company policies and procedures and HIPAA and OSHA policies for all companies for whom Genesis Healthcare Partners provides services.

ESSENTIAL FUNCTIONS:

  • Setting day-to-day goals and performance expectations for the credentialing and provider enrollment team and other team members as needed.
  • Automation of the provider data management and credentialing process through RCM and credentialing information systems for effective provider credentialing and payer enrollment.
  • Management of contract rate databases within RCM and finance. 
  • Financial analysis of payer revenue performance against contracts, identifying root causes of underpayment or overpayments. 
  • Conduct regular payer meetings to resolve payer issues and serve as key payer relations point of contact.
  • All other duties as assigned

QUALIFICATIONS AND SKILLS:

  • Skill in effectively communicating using tact and diplomacy both orally and in writing with physicians, co-workers, administration, and the public.
  • Ability to effectively articulate and present financial information to senior management and staff
  • Expertise in the use of Excel (advanced level), PowerPoint, and Word and able to use computer system and general office equipment to perform job functions
  • Strong Management and leadership abilities
  • Strong financial, statistical, and analytical skills
  • Ability to identify problems and recommend solutions within the scope of his or her authority
  • Ability to apply good judgment in solving everyday problems with calmness
  • Ability to exercise self-initiative, plan, prioritize, and complete delegated tasks
  • Ability to read, understand, and follow oral and written instructions
  • Ability to demonstrate professionalism, compassion and caring when dealing with others and maintaining effective work relationships
  • Ability to maintain strict patient, physician, staff, and corporate confidentiality
  • Ability to effectively train staff
  • Ability to delegate responsibility and authority to staff
  • Ability to establish and monitor performance/productivity standards

EXPERIENCE AND EDUCATION:

  • Bachelor’s degree in Accounting, Finance, Business Administration, or Health Care related field, MBA preferred
  • 5+ years of experience managing a high-volume medical billing/accounts receivable department
  • Experience with the impact of Quality Payment Programs on Revenue Cycle, Payer Contracting, and Credentialing strongly preferred. 
  • Knowledge of state and federal laws that apply to the duties of this position
  • In-depth knowledge of Medicare billing/coding rules and regulations
  • Knowledge of payer contract specifications and management.
  • Knowledge of payer enrollment and credentialing.
  • Experience with RCM systems, including Allscripts Practice Management, Verify Stream Credentialing and Data Management

PHYSICAL DEMANDS:

  • Work may require sitting for extended periods of time; also stooping, bending, and stretching.
  • Requires manual dexterity sufficient to operate a computer keyboard, operate a calculator, telephone, facsimile machine, photocopier, and other office equipment as necessary. 

WORK ENVIRONMENT:

  • Work is performed in a fast-paced, high volume, office environment
  • It is necessary to type and view computer screens for long periods. 
  • Work involves frequent contact with staff members, physicians, and other professionals.
  • Interaction with others is constant and interruptive. 
  • Must be able to work with minimal supervision with the ability to problem solve and make sound decisions. 

TRAVEL REQUIREMENTS:

  • None

To apply for this position, please submit application with attached resume to the Job Opportunities Website:

https://www.mygenesishealth.com/careers/job-opportunities.html

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