Billing Integrity Manager

Description

JOB SUMMARY

Responsible for researching, identifying and implementing regulatory changes to billing systems and edit systems. Responsible for tracking and communication of system changes, impact to billing requirements and policy changes to management.

ESSENTIAL DUTIES AND RESPONSIBILITIESinclude the following. Other duties may be assigned.

• Research, identify and notify key stake holders of regulatory changes Assists business stakeholder with understanding information and supports business stakeholder in defining reporting and system enhancement needs
• Review and provide feedback to managed care contracts
• Review, approve as appropriate and monitor all third party edits
• Develop, publish, track and report all ICE edits
• Assist with compliance and CIA related matters
• Develop and maintain working relationship with HCOs and RCOs ensuring billing compliance and claim integrity
• Assist with the development and implementation of new billing policy ensuring the integrity of claims
• Develop communications and agendas for billing manager meetings, advisory and user groups
• Lead special projects as assigned by Director

SUPERVISORY RESPONSIBILITIES

This position carries out supervisory responsibilities in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

• No. Direct Reports (incl, titles) N/A
• No. Indirect Reports (incl. titles) 1 Analyst

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Excellent communication, customer service and time-management skills
• Good interpersonal skills and ability to work well with other team members and customer/business stakeholders
• Ability to define and document requirements for system enhancements based on business stakeholder requests
• Analytical ability to create/run system queries (ACE, PBAR), as required
• Extensive problem-solving and organizational skills
• High level business skills and understanding of general financial operations and major A/R goals in the healthcare environment
• Strives for continuous improvement through training and other learning opportunities
• Detail-oriented, meticulous, and accurate in completing tasks timely
• Ability to design and implement reporting from the systems necessary to collect, maintain, and analyze information
• Proficient (medium to high skill level) with various desktop applications, such as Microsoft Excel, Word and/or Access

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience required to perform the job.

• B.S. degree in Business or Healthcare related field (preferred)
• 7-10 years business or healthcare business office experience and management experience
• 1-2 years experience in delivering services to internal/external clients
• Project management/facilitation training experience (preferred)

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit for long periods of time;
• use of hands and fingers;
• reaching with hands and arms; talk and hear.
• Specific vision abilities required by this job include close vision.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Normal corporate office environment

OTHER

Provide any additional information or requirements that would be helpful to someone trying to understand the nature, scope or purpose of this position.

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Compensation and Benefit Information

Compensation

• Pay: $72,509.00 - $108,763.00 annually. Compensation depends on location, qualifications, and experience.
• Position may be eligible for an Annual Incentive Plan bonus of 10%-25% depending on role level.
• Management level positions may be eligible for sign-on and relocation bonuses.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, life, and business travel insurance
• Management time off (vacation & sick leave) – min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.