RCM Payer Escalations Director
About The Position
The RCM Payer Escalations, Director, will lead a team to strategically manage claims underpayment escalations, identifying qualifying claims through data reviews, and provide actionable insights to support Managed Care negotiations with third-party payers to ultimately drive claims reimbursement and resolution. You will build strong relationships across various RCM stakeholders, play a critical role in proactively auditing and reviewing claims for payer escalations, oversee entire workflow, monitor performance, and address revenue-impacting trends, using data analytics to optimize processes. To excel in this role, you must have extensive experience in medical billing and coding, strategic leadership, payer relations, data analytics, process optimization, and cross-functional collaboration within revenue cycle management and managed care teams.
Requirements
- Extensive experience in medical billing and coding
- Strategic leadership experience
- Payer relations experience
- Data analytics experience
- Process optimization experience
- Cross-functional collaboration experience within revenue cycle management and managed care teams
Responsibilities
- Work in close partnership with key RCM stakeholders to ensure alignment of strategies and organizational goals
- Lead and mentor a team of RCM professionals, acutely focused on underpayments and proper auditing for successful payer escalation
- Review, audit, and root-cause reasons for payment delays, to ensure proper escalations
- Develop and implement strategies to improve payer escalation processes
- Build, enhance, and maintain the systems and workflows needed to manage all escalated inventory
- Develop and monitor key performance indicators (KPIs) related to payer escalation
- Provide analytics on all aspects of the business, including real-time volumes, balances, resolution detail, resolution rates, and trends
- Prepare and present reports on payer performance and escalation outcomes to senior leadership on a routine basis
- Utilize data analytics to identify patterns and root causes of payer-related issues
- Monitor and analyze payer performance, identifying trends impacting revenue
- Lead a high-functioning team of AR resolution experts & drive leadership accountability to meet and exceed performance targets
- Develop team members to proactively identify and understand revenue cycle issues in conjunction with payor contracts and adjudication practices
- Conducts a strong team culture of collaboration, being in service to our partners, internal departments, and each other to drive results
- Implement best practices and innovative solutions to enhance efficiency and effectiveness
- Ensure compliance with industry regulations and standards throughout the escalation process
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
Number of Employees
501-1,000 employees
