Revenue Intelligence Manager

Spartanburg Regional Healthcare System•Spartanburg, SC

About The Position

The Manager, Revenue Intelligence reports directly to the Vice President of Strategic Finance and is responsible for system-level revenue optimization and will lead the organization in the development and implementation of a comprehensive revenue intelligence strategy. This position is a highly analytical, hands-on leadership role that demands a deep understanding of healthcare payment methodologies, revenue integrity, claims and revenue cycle processes, EHR functionality, health economics, financial reporting, and data analytics. The Manager will lead a team of analysts and collaborate with key internal stakeholders to develop revenue intelligence, perform complex economic modeling, and enhance margin.

Requirements

Bachelor’s degree in Accounting, Finance, Computer Science, or any quantitative or applicable healthcare related field
5+ years healthcare experience with a specific focus in revenue, data analytics, decision support, managed care, or a related field
Exceptional analytical, critical-thinking, and problem-solving skills
Experience with complex economic models, actuarial analysis, statistics, or advanced financial analysis
Expert knowledge of healthcare payment methodologies, rate structures, reimbursement, and revenue management
Highly developed communication skills to effectively convey complex, detailed information clearly and concisely to internal customers, translating complex ideas into compelling, actionable recommendations
Demonstrates systems-based thinking and able to identify trends to take advantage of opportunities to drive continuous improvement
Ability to work independently, self-motivated, innovative, shows initiative, creative in overcoming obstacles, and results-focused

Nice To Haves

Master’s degree preferred
2+ years supervisory or management experience

Responsibilities

Serves as the revenue intelligence subject matter expert for the organization, providing support to and collaborating with Reimbursement, Revenue Cycle, Payor Strategy, Net Revenue, Financial Planning and Analysis (FP&A), Operational Finance, and Regional Healthplus, LLC (Population Health division).
Leverages knowledge of fee-for-service (FFS) and value-based (VB) reimbursement methodologies to identify synergistic opportunities & guide system-level revenue enhancement strategies.
Develops tools and processes to effectively map the organization’s comprehensive revenue landscape (IP, OP, Physician, Post-Acute, Value-Based Care, etc).
Optimizes and leverages Epic expected payment calculations, RCA platform, and other data resources to enhance revenue mapping capabilities, improve yield, and drive performance improvement efforts.
Responsible for Epic expected payment build, maintenance, and analysis.
Collaborates with the Enterprise Intelligence and Analytics team to develop advanced data and analytics tools needed to support comprehensive revenue intelligence and more effectively leverage internal and external payment data.
Identifies and leads cross-divisional improvement projects designed to address gaps and optimize revenue.
Develops and maintains complex economic models including detailed revenue projections to evaluate financial impact and support strategic initiatives (e.g. new service lines, acquisitions, payor and case mix, strategic planning, cost-saving and revenue enhancement opportunities).
Advances FFS and VB payment modeling techniques, performs what-if modeling based upon actuarial assumptions, and analyzes feasibility and/or impact of different payment methodologies and/or utilization patterns.
Tracks, trends, and monitors revenue integrity and oversees development of appropriate expected payment KPIs.
Translates complex payment methodologies and third-party payment performance issues into actionable business insights.
Drives revenue intelligence and payment integrity business initiatives – coordinates with key stakeholders across divisions to identify and prioritize opportunities, provides decision support and project management to evaluate and advance solutions.
Ensures organizational revenue reporting and analytics reflects revenue enhancing strategic priorities.
Communicates revenue intelligence strategy and priorities to all key stakeholders, including operational and clinical leadership.
Responsible for Strategic Pricing and Price Transparency.
Oversees the maintenance of Employee Health Plan fee schedules.
Supports FP&A in development of assumptions for annual operating budget and long-range financial plan.