CRC Operations Manager

Description

JOB SUMMARY

• Responsible for the daily activity of a team of clinicians and/or coding auditors as they evaluate accounts for appeal
• Responsible for inventory management and team performance
• Provides guidance in the development and oversight of unit processes and procedures related to the appellate solution and RAC solution
• Works closely with the operations supervisor to address performance management opportunities

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Performance Targets – Monitors performance targets. Identifies opportunities for improvement and implements improvement plans
• Operations – Manage supervisors and staff as it relates to daily operations, special projects and process improvement plans. Responsible for all aspects of day-to-day supervision and leadership of CRC clinicians and coders. Works with external partners on special projects
• Issues & Escalations – Identifies operations issues and escalates to department leaders; supports execution of action plans
• Collaboration – Attends meetings with AR teams as needed. Shares insights gained through supervisors and team members. Attends client-facing meetings to resolve concerns and share insights. Collaborates with mid-cycle Coding Audit Team leaders for topics related to CRC coding auditor operations and appeals
• Strategizing – Supports the Operations Director in execution of special projects, new client implementation and process development / refinement activities
• Goals – Communicates operational goals and supports leaders and team members to successfully achieving goals
• Training and Development – Identifies opportunities for training; provides professional development opportunities to supervisors and team members
• Performance Management – Works closely with supervisors to monitor performance, identify opportunities for improvement, and provide coaching and / or disciplinary action as needed. Responsible for approving team member time and attendance
• Culture – Maintains an environment that supports high-motivation, positive morale, employee engagement and growth opportunities
• Leadership Support – Identifies and gathers data for internal and client discussions

SUPERVISORY RESPONSIBILITIES

If direct report positions are listed below, the following responsibilities will be performed 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.

• Direct Reports (titles) Operations Supervisor, Coding Auditor, Appellate Clinician
• Indirect Reports (titles) N/A

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.

• Government and Commercial Payers – NCDs/LCDs and ability to research payer specific policies
• Technology – Experience with multiple CM / HIM technology solutions and MS Word, Excel and PowerPoint
• Coding and DRG – Familiar with DRG classification and reimbursement structures
• Communication – Written and verbal communication skills
• Revenue Cycle – Understanding of healthcare and revenue cycle services as it relates to payer denials
• Teaching – Ability to conduct on-line education sessions
• Other – Flexible, innovative and highly adaptable to dynamic business environment, catalyst for change. Highly engaged and supportive of leadership. Role model for Conifer values and guiding behaviors.
• Analytics & Performance Improvement – Experience with data, analytics, and performance improvement activities
• Organizational Skills – Effectively manages competing priorities. Ability to formulate and develop new and innovative strategies and services
• Medical Necessity Tools – Proficient in the application of medical necessity criteria

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

• 2 years of acute care hospital nursing experience
• 2 years of leadership experience or educational equivalent
• 1 year of hospital case management or utilization review experience
• Preference for experience working for a managed care organization, appeal writing experience or revenue cycle experience

REQUIRED CERTIFICATIONS/LICENSURE

• Registered Nurse (RN), Licensed Vocational Nurse (LVN), or Licensed Practical Nurse (LPN)
• Utilization Review or Case Management Certification and / or certification as Revenue Cycle Representative (CRCR) or Certified Financial Healthcare Professional (CFHP) - 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.

• Must be able to work in sitting position, use computer and answer telephone
• Ability to travel
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

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.

• Office Work Environment
• Hospital Work Environment

OTHER

• Approximately 50% travel may be required

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: $81,952.00 - $122,907.00 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.