Surgical Care Affiliates

  • Revenue Cycle, Out of Network Manager

    Job Location US-TX-Dalls
    Type
    Full-Time
    # of Openings
    1
  • Overview

    SCA, a leader in the outpatient surgery industry, strategically partners with health plans, medical groups and health systems across the country to develop and optimize surgical facilities. SCA operates more than 210 surgical facilities, including ambulatory surgery centers and surgical hospitals, in partnership with approximately 7,500 physicians. For more information on SCA, visit www.scasurgery.com

    Accountabilities / Responsibilities

    Reporting to the Site Engagement Director, and supervising the Out of Network Specialist, this position is responsible for developing and implementing an Out of Network (OON) strategy that will support physicians and their patients by providing compassionate, accessible, cost effective healthcare, while optimizing cash collections and conducting business in a manner that is compliant with state specific guidelines. This position will support facilities that are managed in both the Dallas and Indianapolis Central Billing Office and may require some travel between both centralized business offices.

    • Serve as primary point of contact for all Out Of Network (OON) related functions
    • Initiate proactive communication by identifying cause and effect with the necessary steps and parties for resolution
    • Engage with payers and third-party vendors to negotiate the reimbursement for various types of surgical claims, both pre and post service
    • Analyze and interpret claims information regarding the reimbursement of surgical claims and provide proactive feedback to Central Billing Office leaders and Out Of Network teammates to determine if process updates or changes are needed
    • Build and educate around understanding of payer/employer payment tendencies and patterns
    • Research Summary Plan Descriptions for various employers in order to determine case profitability to help build the data kingdom with ERISA information
    • Optimize reimbursement on eligible cases by generating additional revenue by compiling data-driven payer reconsiderations and appeals
    • Monitor, review and share any “Surprise Billing” notes, referendums, or bills passed by state or federal government
    • Perform all other duties as assigned by management

    Qualifications

    • High School diploma required
    • 3-5 years of revenue cycle experience with heavy out of network presence
    • Ability to travel approximately 30% nationwide
    • Ability to lead a team through mentorship and open communication, including how to analyze all data related to Out of Network processes, payer behaviors, etc.
    • Demonstrated leader in solving complex revenue cycle issues and implementing change management when needed
    • Possess a broad knowledge of obtaining specific Out of Network payer data elements
    • Excellent analytical, verbal and written skills
    • Expert experience and knowledge in revenue cycle management, specifically Out of Network practices
    • Ability to negotiate and influence outcomes
    • Highly organized and very detail oriented with superior time management and prioritization skills
    • Familiarity with state laws/regulations pertaining to out of network business

    Please click HERE to apply.

    2019-6536

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