Cleveland Clinic is seeking an engaging, organized and experienced leader to serve as Department Manager III – Revenue Cycle Management Payment Assurance and Compliance. This leader will play a key role, working as a strategic visionary to drive dashboards, metrics and processes to success.
The Department Manger III manages and controls annual budgets, and leads the planning, workflow analysis, procedure changes, scheduling and related administrative duties. This leader will specialize in payor contracts, including Anthem, Aetna and more, modifying work queues to eliminate issues and improve processes and presenting and reporting to leadership.
A caregiver in this role works remotely, from 8 a.m. — 5 p.m.
Caregiver must reside in Ohio, Florida or Nevada.
A caregiver who excels in this role will:
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Manages department personnel and operations, which includes staffing, training, workflow analysis and performance management.
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Manage staffing to ensure appropriate allocation and compliance with goals and objectives.
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Monitor quality and financial performance.
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Ensure compliance with government health regulations, JCAHO guidelines, quality requirements and customer service standards.
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Recommend enhancement and cost–saving strategies.
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Resolve interdepartmental issues to ensure consistency in quality, procedure and policy application.
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Develop, monitor and implement programs to enhance customer service, develop skills and improve scope of service.
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Analyze programs and make improvements.
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Participate in managers’ meetings and relevant committees as assigned.
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Expert in understanding Government and Managed Care terms and conditions, methodologies and adjudication rules
- Subject matter expert (SME) in the identification of payment discrepancies, pursuit of underpayments and recovery tracking.
- Assists in the development, implementation and execution of quality control programs for timely and accurate resolution.
- Provides recommendations to leadership regarding adjudication and payer performance
- Recommends and executes changes to internal processes to align with state, federal and private insurance regulations
- Interaction and oversight of the management reporting systems to ensure accurate and timely reporting of department goals and results.
- Familiarity with payor websites and portals as well as active engagement in payor operational meetings
- Collaboration with various Revenue Cycle areas including, but not limited to, Patient Access, Health Information Management, Revenue Resolution, Clinical Documentation, Revenue Integrity, Market & Network Services, Contract Management, Financial Reporting, Enterprise Analytics and Cash Application
- Ability to foster positive working relationship with internal and external Payor Specialists, Departments, Institutes and fellow Caregivers
- Team player with strong written and verbal communication skills.
- Proficient in Epic and Microsoft suite of products
- Ability to produce quality outcomes that are both accurate and timely.
- Innovative mindset focused on Continuous Improvement and automation opportunities
Minimum qualifications for the ideal future caregiver include:
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Bachelor's degree in business administration, healthcare administration or related field and five years of supervisory or management experience in a related setting
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OR master’s degree and four years of experience
Preferred qualifications for the ideal future caregiver include:
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Healthcare experience
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CPT code, DRG
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Contract Management experience
Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we’re dedicated to providing what matters most to you: https://jobs.clevelandclinic.org/benefits-2/
Physical Requirements:
- Manual dexterity sufficient to operate office equipment.
- May require extended periods of sitting, standing and walking.
- Must be able to walk to attend meetings; must have normal or corrected vision to normal range.
- Ability to clearly communicate by phone and in person. Occasional lifting up to 25 pounds.
Personal Protective Equipment:
- Follows Standard Precautions using personal protective equipment as required for procedures.
Pay Range
Minimum hourly: $33.46
Maximum hourly: $51.03
The pay range displayed on this job posting reflects the anticipated range for new hires. While the pay range is displayed as an hourly rate, Cleveland Clinic recruiters will clarify whether the compensation is hourly or salary. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set, and education. This is not inclusive of the value of Cleveland Clinic’s benefits package, which includes among other benefits, healthcare/dental/vision and retirement.
Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.
Please review the Equal Employment Opportunity poster
Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities
The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. All new caregivers must clear a nicotine test within their 90-day new hire period. Candidates for employment who are impacted by Cleveland Clinic Health System’s Smoking Policy will be permitted to reapply for open positions after one year.
Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.