Manager, Revenue Integrity

Overview

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives - and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It's also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Manager of Revenue & Contracting Strategy (MRCS) is responsible for leading the modeling and analytic analysts/lower level managers for the Network wide revenue functions for Hackensack Meridian Health's (HMH) wholly owned entities (Hospitals, Ambulatory Care Models and Services, Physician Services, Home Care, Hospice, Infusion, and DME). Lead in the Managed Care Contract Modeling analytics; Revenue Integrity analytics; Charge Master Analytics; the Contract Management System analytics and build and the Price Transparency analytics and build. This position requires a unique skill set with the ability to understand relational databases, a comprehensive knowledge of system charging/billing and managed care contracting as well as an understanding of general accounting principles. The MRCS works closely with Finance, Population Health, Managed Care, Revenue Cycle, Information Technology, and Clinical/Operational leadership to advance HMH goals and objectives:

• Complete and review all Managed Care modellings required for the evaluation and rate setting of the managed care contracts.
• Design and implement revenue reviews/analytics to ensure revenue integrity throughout the Network. Including Contract claims reviews.
• Perform annual CDM benchmarking analytics and modeling to develop and set charge pricing. This aligns HMH's strategic objectives, price transparency, and defensible pricing while maximizing revenue opportunities.
• Responsible for the accurate development, implementation, and maintenance of all payor and contractual logic builds within the EPIC contract management system that calculates HMH's claim level expected revenue.
• Develop, design, produce, and maintain approved Price Transparency files.
• Optimize revenue and market share growth via the revenue setting process which Focuses on managed care pricing and contractual analytics, charge system infrastructure builds, and charge price setting to meet the emerging needs of the health system.

Responsibilities

A day in the life of a Manager of Revenue & Contract Strategy with Hackensack Meridian Health includes:

• Managed Care - Managed Care revenue development & integrity on $3.5 billion portfolio
  • Provide leadership in modeling the financial impact of contract proposals and recommend rate strategies to achieve the desired outcome.
  • Provide leadership in performing quarterly impact analysis and annual reconciliations of MCO Utilization Management financial programs.
  • Provide leadership in identifying areas of concern impacting revenue by closely monitoring financial performance and compliance with managed care contract terms to ensure revenue is maximized.
  • Provide leadership in identifying areas impacting revenue by developing models to analyze payor trends focusing on utilization, service mix, product shifts, revenue cash collections and write-offs.
  • Provide leadership in analyzing and modeling value based/shared savings contractual terms such as revenue guarantees to ensure accuracy of reimbursement received.
• Contract Management System (CMS)
  • Provide leadership in the development, implementation and maintenance of all payor/contractual logic builds to ensure correct expected reimbursement is calculated which is vital for patient financial services to properly collect on claims.
  • Identify billing, collection and contract issues impacting revenue.
  • Maintain up-to-date knowledge of current and emerging information regarding payer contracts, Medicare legislation, regulations, market activity, and industry trends.
  • Lead reimbursement audits to determine accuracy of expected reimbursement and to ensure contract compliance.
• Charge Master Analytics (CDM)
  • Assist the Director in the annual Charge Master Price setting. Assist in the analytics to enhance reimbursement and maximize revenue while adhering to the executive strategy and price transparency initiatives of the Network.
  • Assist the Director with analytic evaluation of CDM to Managed Care contracts to ensure maximum contract yields.
  • Assist Charge Master Director as needed in evaluation pricing for new EAP's
  • Assist the Director with development and preparation of the annual managed care reserve calculations.
• Price Transparency - Assist the Director with the review and interpretation of regulatory requirements related to Price Transparency for HMH.
  • Assist with implementation and maintenance of the `comprehensive machine-readable file' requirements for `standard charges' and `items and services' applicable to each HMH hospital and every negotiated payor specific payment term
  • Assist with implementation and maintenance of HMH's price estimator tool for `the shoppable 300' services, which provide `standard charges' on at least 300 `shoppable services' for each HMH hospital.
  • Assist with ensuring HMH is compliant with regulatory data and accessibility requirements.
• Other
  • Other projects as requested by the Director.
  • Mentor and guide the Manager of Revenue & Contracting Operations.
  • Hire, develop and manage a highly qualified revenue operations/analytics team. Ensure integrity, compliance, accuracy, and completeness for department.
  • Provide continuous education and growth of team members
  • Adhere to HMH Organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills and Abilities Required:

• Bachelor's in finance or related MIS degree.
• Eight or more years of experience in financial analytics.
• Two or more years of experience in managed care contract management.
• Effective oral and written communication.
• Collaboration with other team members.
• Excellent written and verbal communication skills.
• Proficient computer skills that may include but are not limited to Microsoft Office and/or Google Suite platforms.

Education, Knowledge, Skills and Abilities Preferred:

• Masters in MIS/Data Analytics.
• MBA in finance.
• Two or more years of direct relational database experience with catalyst and/or SQL.

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!