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:

• Manages department personnel and operations, which includes staffing, training, workflow analysis and performance management.

• Manage staffing to ensure appropriate allocation and compliance with goals and objectives.

• Monitor quality and financial performance.

• Ensure compliance with government health regulations, JCAHO guidelines, quality requirements and customer service standards.

• Recommend enhancement and cost-saving strategies.

• Resolve interdepartmental issues to ensure consistency in quality, procedure and policy application.

• Develop, monitor and implement programs to enhance customer service, develop skills and improve scope of service.

• Analyze programs and make improvements.

• Participate in managers’ meetings and relevant committees as assigned.

• 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:

• Bachelor's degree in business administration, healthcare administration or related field and five years of supervisory or management experience in a related setting

• OR master’s degree and four years of experience

Preferred qualifications for the ideal future caregiver include:

• Healthcare experience

• CPT code, DRG

• Contract Management experience