Revenue Cycle Manager- Clinical Audit

Johns Hopkins Medicine•Baltimore, MD

2d•$48 - $75•Remote

About The Position

You were meant for Hopkins ! Come see why the Johns Hopkins Hospital is a world-renowned leader in patient care, serving the greater Baltimore community and patients from all across the globe. Our friendly and knowledgeable staff teams provide support throughout our many specialty departments and centers, from primary visits to emergency care. What Awaits You? Career growth and development Diverse and collaborative working environment Affordable and comprehensive benefits package including Tuition Reimbursement The Revenue Cycle Manager of Clinical Audit and Administrative Appeals is responsible for the development and management of programs related to regulatory reimbursement, including but not limited to the oversight of the Recovery Audit Contractor implementation and Medicaid Integrity Project, and the denial and appeal processes for emergency, outpatient, and inpatient encounters as performed by the Nurses and Claims Analysts for the JHH, JHBMC, HCGH, SMH, SH and ACH. The Manager also has direct responsibility for the Outsource Nurse, Administrative Coordinator and Staff Assistant processes that support RCM and the denial and appeal processes. This position reports directly to the Director of Appeals and Revenue Integrity and provides support for Payor Management and implements the organization’s regulatory reimbursement management plan in accordance with the mission and strategic goals of the organization, federal and state law and regulations, payer requirements and accreditation standards. The Manager also provides other JHM entities support in project planning and implementation along with supervising and recruiting departmental registered nurses. Hours : Full time (40 hours) Day Shift, Weekdays Location : Remote- Requires current Registered Nurse Licensure in the State of Maryland.

Requirements

Bachelor’s Degree or Associate Degree in Nursing from an accredited School of Nursing.
Requires current Registered Nurse Licensure in the State of Maryland.
15 years of direct management experience in an academic health system.
Excellent knowledge base related to nursing and reimbursement practices, financial and data analysis, third party payer regulations, utilization management standards, case management methodologies, age specific and other regulatory and accreditation requirements related to Care Coordination and cost containment.

Responsibilities

development and management of programs related to regulatory reimbursement
oversight of the Recovery Audit Contractor implementation and Medicaid Integrity Project
denial and appeal processes for emergency, outpatient, and inpatient encounters as performed by the Nurses and Claims Analysts for the JHH, JHBMC, HCGH, SMH, SH and ACH
direct responsibility for the Outsource Nurse, Administrative Coordinator and Staff Assistant processes that support RCM and the denial and appeal processes
support for Payor Management
implements the organization’s regulatory reimbursement management plan in accordance with the mission and strategic goals of the organization, federal and state law and regulations, payer requirements and accreditation standards
provides other JHM entities support in project planning and implementation along with supervising and recruiting departmental registered nurses