System Director Revenue Applications

Thank you for considering a career at Bon Secours Mercy Health!

SYSTEM DIRECTOR REVENUE APPLICATIONS

Home Office - Cincinnati, OH

The System Director of Revenue Applications is responsible for designing and creating data reporting platforms and tools that help others on the revenue management team with government reporting, revenue analytics and insights, data extraction, and adhoc reporting business and clinical information needs. The System Director Revenue Applications will create an intake process to clarify requirements and, using their expertise, determine the feasibility, assign responsibilities and determine strategy for best method to meet request. The incumbent will develop in depth knowledge of the reporting tools available and source data models. This position is responsible for developing, managing, and leading the day-to-day activities associated with managed care contracting for both fee for service and risk agreements within a specified market. The work of the incumbent will be focused on developing and implementing new insurance and risk-based contracts and on evaluating, monitoring and maintaining existing insurance and risk based contracts. The contracts will primarily include facilities, ancillaries, physicians, PHO’s and clinically integrated networks for a specific state where Bon Secours Mercy Health operates.

Essential Functions

Primary areas of responsibility will include:

• Responsible for tracking the performance of Revenue Management vendors in relation to their SLA’s documented in the contract
• Develop tools and reporting to support the following:
  • Operations analytics on timeliness and accuracy of contract loading
  • Payor analytics and tracking around Fee Schedule, Grouper and CDM notifications
  • Work with modeling vendors to develop robust payor performance reporting around behavior including denials, underpayments, patient responsibility and other administrative or policy burdens
  • Create reports to support auditing and accuracy of Epic modeling performed by Ensemble
  • Maintain and enhance Revenue Management databases for standardized reporting on Managed Care Analytics for Hospitals, Medical Group and Ambulatory/Ancillary
• Communicate trends and insights on a monthly and quarterly bases that can be used by both operators and the revenue management team
• Develop market strategy packets to be used by both the Managed Care Negotiators and Modeling teams to drive decision making

• Work within the markets as necessary on the standardization of processes, reporting and approaches to payer contracting, payer relationships, network participation and other strategic project from time to time.

• Participates in short and long term projects, as needed.\

• Maintains knowledge and understanding of the current trends and developments in healthcare reimbursement and development of specific payer strategies, including investigation of new business opportunities, regulations, standards and directives regarding governmental/third party agencies (Medicare & Medicaid) and/or third party payers.

• Adheres to the standards and policies of the Corporate Responsibility Program, including the duty to comply with applicable laws and regulations, and reporting to designated Manager (or employer hotline) any suspected unethical, fraudulent, or unlawful acts or practices.

• Participates in and encourages associates to participate in activities that benefit the community.

• Performs other duties and responsibilities as may be assigned from time to time.

• This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job related duties as required by their supervisor, subject to reasonable accommodation.

REQUIRED:

• Bachelor's Degree in Business Administration or Healthcare Administration or closely related field (with adequate understanding of healthcare finance)
• MINIMUM of 10 years of of hospital contracting or payer contracting experience.
• Excellent interpersonal skills to interact with all levels of staff, outside vendors, consultants, and physicians.
• Strong analytical, verbal and presentation skills; experience in financial modeling and reimbursement technologies; proficient in spreadsheet and database programs as well as legal and contractual compliance issues. Ability to establish relationships with internal customers and managed care entities. A broad knowledge of the healthcare industry, insurance, managed care and integrated delivery systems as well as employer benefit plans. A background in healthcare finance, payer reimbursement methodologies and decision support leadership is preferred. Must have the ability to timely and accurately mine data from various internal and external sources and organize information in a meaningful way for presentation and analysis. Must possess critical thinking skills, an ability to work cooperatively with others and have a positive, willing attitude. Geographic mobility as necessary.

PREFERRED:

• Masters in Health Care Administration, Accounting or Finance

Bon Secours Mercy Health is an equal opportunity employer.

We’ll also reward your hard work with:

• Comprehensive, affordable medical, dental and vision plans
• Prescription drug coverage
• Flexible spending accounts
• Life insurance w/AD&D
• An employer-matched 403(b) for those who qualify
• Paid time off
• Educational Assistance
• And much more

Scheduled Weekly Hours:

Work Shift:

Department:

All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you’d like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com.