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Providence Health & Services Senior Manager, RC Legal Services Ministry Coordination PSJH in Alaska

Description:

Providence St. Joseph Health is calling a Senior Manager, RC Legal Services Ministry Coordination PSJH. This position is open to candidates residing in Alaska, Washington, Montana, Oregon, California or Texas.

Applicants that meet qualifications will receive a text with additional questions from our Modern Hire system.

We are seeking a Senior Manager, RC Legal Services Ministry Coordination PSJH who will be responsible for serving as the primary point of PSJH Revenue Cycle relationship management for the payer escalation and legal escalation processes across all states and ministries served. The Senior Manager, Legal Services is accountable for the development of relationships and collaboration with Payer Contracting, Legal, and Payers to improve appeal turnaround and dispute resolution. This role is responsible for review of new and existing payer contracts, offering feedback to Payer Contracting to ensure payer contracts can be operationalized. The role is accountable for monitoring payer issues and performance, as well as relationships with legal escalation vendors, to drive discussions towards delivery of timely best-in-class performance results. The Senior Manager, Legal Services is responsible for audits of the Revenue Cycle payer contracting and legal escalation processes, policies, procedures, and practices for effectiveness, to identify and implement strategic opportunities to streamline practices, thereby improving appeal and dispute resolution. The role establishes legal services success metrics and performs detailed analysis and reporting on vendor trends and communicates strategic insights to Revenue Cycle leadership, Revenue Cycle Regional Executive Partners, and stakeholders. The Senior Manager, Legal Services also maintains comprehensive knowledge of related legal or regulatory policies across all states served to ensure compliance is maintained. The Senior Manager oversees analysts responsible for account reconciliation with legal vendors, performing audits, and tracking payer and vendor performance.

The Senior Manager, Legal Services will partner with other Revenue Cycle leaders, Payer Contracting, Revenue Cycle Regional Executive Partners and IS on process improvement, technology innovation, analytics, compliance, and vendor management. The Senior Manager, Legal Services is responsible to ensure policies and procedures are current and enforced, business practices are compliant, and a high level of patient and customer satisfaction is maintained across the region.

Promotes an environment shaped by health, healing, hope, diversity, and mutual respect. Is self-directed and requires minimal supervision.

In this position you will have the following responsibilities:

  • Acts as the primary point of Revenue Cycle contact for all PSJH Revenue Cycle payers, Revenue Cycle leaders, Revenue Cycle Regional Executive Partners, and legal escalation vendors to identify payer issues and facilitate timely resolution of appeals and disputes.

  • Partner with PSJH Payer Contracting to review new and existing payer contracts, offering feedback so that contracts can be easily operationalized.

  • Organize and conduct regular meetings, including Joint Operating Committees, with payers to discuss the details and status of appeals and disputes across the PSJH ministries, focusing on timely satisfactory resolution and service levels.

  • Maintain a strong working relationship with all existing payers and legal escalation vendors, overseeing successful service level agreements and best-in-class performance results.

  • Maintain industry and operational knowledge related to legal escalation vendors, including legal and regulatory policies, for performing timely knowledge-based decision-making to achieve best-in-class performance results.Provide strategic oversight and identify, design, and implement payer and legal escalation best practices to streamline processes, eliminate variation or duplication, and drive down operational expenses.

  • Manage the transition from a regional payer and legal escalation service delivery and support model to an enterprise model.

  • Build relationships with new payers and legal escalation vendors the organization brings on, and manage successful transition, ensuring quality and performance results are maintained.

  • Manage operational or systems/technology resources to ensure transmission and reconciliation of assignments to legal escalation vendors, and proper handling of returned accounts.

  • Collaborate with Payer Contracting, Revenue Cycle leadership, Revenue Cycle Regional Executive Partners, CFO's and other PSJH leadership to influence and, where possible, enforce payer service level agreements related to appeals and disputes.

  • Organize, oversee or conduct audits to ensure all relevant PSJH policies and procedures, service level agreements, and state regulations are followed by legal escalation vendors.

  • Partner with Revenue Cycle Data & Analytics to facilitate payer and legal escalation vendor related success metric reporting for all PSJH ministries.

  • Analyze payer and legal escalation vendor related data trends across PSJH ministries and report detailed and strategic insights to Revenue Cycle leadership.Organize and conduct regular meetings with legal escalation vendors to discuss the details and status of account payment disputes across the PSJH ministries, quality, and service levels.

  • Establish procedures and perform legal escalation vendor invoice review, reconciliation and control.

  • Partner with Revenue Cycle Payer Yield leadership and other PSJH ministry departments, including information systems, to meet goals.

  • Exercise creative approaches to problem solving. Deal with conflict and problematic situations in an open and tactful manner, respecting the dignity of others.

  • Perform other duties as assigned.

Qualifications:

Required qualifications for this position include:

  • 7 years experience in a medical business office setting. Knowledge in reimbursement of healthcare accounts from insurance companies.

  • 7 years experience in a healthcare organization or insurance company.

Preferred qualifications for this position include:

  • Bachelor's Degree in business, finance, health care administration -OR- equivalent education/experience.

  • 5 years Prior vendor management related experience. Prior revenue cycle payer contracting related experience.

About the department you will serve.

Revenue Cycle Services throughout Providence support our patient’s financial journey as part of an enterprise-wide human-centered, technology-enabled care continuum. Our family of organizations works across the western US in Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We strive to provide best-in-class revenue cycle services with highly skilled revenue cycle talent. Our Providence Promise of “Know me, care for me, ease my way” is the foundation of our interactions with our patients and caregivers.

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit

https://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Non-Clinical Director/Executive

Location: Oregon-Portland

Other Location(s): Montana, California, Washington, Oregon, Texas, Alaska

Req ID: 312137

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