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Manager, Contract Payment Systems
Req ID: 45523BR
Job Summary: The Manager of Contract Payment Systems will be responsible for the development, management and maintenance of applications that identify recoveries contractually owed by payers to our Beth Israel Lahey Health Facilities and Physician Groups. This individual will be in charge of performance measurement tools that support identification of underpayments and contract simulation modeling. The deliverables of this individual will be a direct input towards contract rate negotiation and related analytics. The Manager will assist in the training and development of junior staff, manage projects and work closely with all members of the Reimbursement and Contracting work teams, as well as Patient Financial Services personnel.
- Responsible for installation of and day-to-day operations of the contract payment system for all Beth Israel Lahey Health Facilities and Physician Groups. The Manager will be responsible for managing daily input of system files into the contract payment system and working with the Revenue Systems and Billing teams to reconcile the data with the patient billing system.
- Developing research, analysis and recommendations related to Beth Israel Lahey Health System's work with payers including: review and interpretation of insurance contracts, researching policies and practices not documented in payer/provider contracts (i.e. payment policies, medical policies, edit, etc.).
- Responsible for analysis of claims variance including the generation of daily variance reports, and perform root cause analysis. Provide analytic support and contract modeling input in the valuation of new insurance contracts and optimization of net revenue impact.
- Submit appeals in a timely manner to maximize recoveries.
- Collaborating with members of patient accounts, patient access, department managers, provider representatives and contract payers in issue identification and resolution.
- Responsible for generation and quality of output from the contract payment system including running ad-hoc reports as well as contract simulation upon request by the payer contracting team.
- Providing advisory input on denials and billing, from the perspective of a Reimbursement Subject Matter Expert.
- Managing special projects upon request by Hospital Leadership, including but not limited to longer term integration with financial planning and revenue cycle applications.
- Identify and synthesize the ramifications of complex issues, with the ability to independently produce clear financial analysis in response to the issue.
- Prepare complex financial analysis and present recommendations through all modes of communication, including orally, written, and through the presentation of data.
- Has the authority to direct and support employees daily work activities. Has the direct responsibility to undertake the following employment actions: hiring, termination, corrective action and performance reviews. Direct Reports: 4-6 Indirect Reports: None
- Assists in planning, monitoring and/or managing budget in functional area of department.
- High School diploma or GED required. Bachelor's degree preferred.
- More than 10 years related work experience required and 5-8 years supervisory/management experience required
- Development and/or management experience with Contract Payment Systems. 5 plus years of billing experience across all payers both private and government. In addition, proven hospital billing and remittance experience working with 837 and 835 claim files and an understanding of CPT and HCPC and diagnostic coding.
- 5 plus years of proven experience in hospital contract management and payment systems functions. Knowledge of hospital accounting, finance and business management and extensive knowledge of analytical methods and techniques.
- High analytical thinking with demonstrated talent for identifying, scrutinizing, improving and streamlining complex work processes. Ability to operate effectively in a fast paced constantly changing environment. Familiarity in research approach of healthcare insurance policies.
- Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.
- Decision Making: Ability to make decisions that are guided by precedents, policies and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area.
- Problem Solving: Ability to address problems that are highly varied, complex and often non-recurring, requiring staff input, innovative, creative, and Lean diagnostic techniques to resolve issues.
- Independence of Action: Ability to set goals and priorities for functional area. May make recommendations for department policies, practices and programs. Manager or Director provides broad guidance and overall direction.
- Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.
- Oral Communications: Ability to verbally communicate complex concepts in English and address sensitive situations, resolve conflicts, negotiate, motivate and persuade others.
- Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.
- Team Work: Ability to lead collaborative teams for larger projects or groups both internal and external to the Medical Center and across functional areas. Results have implications for the management and operations of multiple areas of the organization.
- Customer Service: Ability to lead operational initiatives to meet or exceed customer service standards and expectations in assigned unit(s) and/or across multiple areas in a timely and respectful manner.
Physical Nature of the Job:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally
EOE StatementBIDMC is EOE M/F/VET/DISABILITY/GENDER IDENTITY/SEXUAL ORIENTATION
VaccinesAs a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. BILH requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment.
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