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Assistant Director Fiscal Affairs, Managed Care Administration
2 months ago
About NYC Health + Hospitals:
Empower Every New Yorker — Without Exception — to Live the Healthiest Life Possible
NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city’s five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible.
At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.
Job Description:
SUMMARY OF ESSENTIAL DUTIES AND RESPONSIBILITIES:
The Central Office Managed Care team is seeking to hire an Assistant Director with experience in healthcare reimbursement to drive additional revenue generation for the city’s public hospital system through the monitoring of claims paid based on terms in organization’s managed care contracts. This role involves knowledge of healthcare claims, contract language, payment methodologies and state and federal guidelines. This person will report directly to the Managed Care team.
• Support Director of Fiscal Affairs to monitor aging accounts receivables from managed care organizations (MCO) by identifying non-payment and underpayment trends in hospital, clinic and post-acute claims adjudication.
• Perform in-depth analysis of claims payment data and EPIC accounts for multiple payors and product lines. This work entails leveraging knowledge of Commercial and governmental insurance plan guidelines and reimbursement practices.
• Independently liaise with MCO provider relations contacts at contracted payors through routine email communications and recurring and ad-hoc meetings to facilitate issue resolution. Communicate findings with internal stakeholders.
• Develop reports and metrics for senior leadership and other Central Office departments to track revenue and advocate for areas of improvement using EPIC and other reporting tools.
• Collaborate with internal operational areas, Central Office departments and some external vendors, to identify denial and underpayment trends and revenue growth opportunities to present to senior leadership and MCO.
• Identify and advocate for areas in need of process improvement to reduce denial rates and payment variances such as EPIC contract maintenance, adherence to contract terms, billing modifications and operational workflows.
• Assist hospitals and ancillary facilities in escalation of appeals and disputes of aged cases by monitoring Epic work queues on a routine basis and compiling well organized files of claims to be distributed to contracted payors for escalated review to generate missing payments.
• Assist in special revenue projects, as needed, to gather and analyze data, perform research and create reports and databases.
• Other duties as assigned.
Minimum Qualifications:
1. Master’s degree from an accredited college or university in Accounting, Finance, Business Administration or a related discipline with an emphasis on accounting and financial systems; and two (2) years of responsible-level experience in fiscal management or administration with an emphasis on financial systems, management information and controls, one (1) year of which must have been in a responsible administrative or managerial capacity; or
2. Bachelor’s degree from an accredited college or university in disciplines, as listed in “1” above; and three (3) years of experience, as described in “1” above, one (1) year of which must have been in a responsible administrative or managerial capacity.
NYC Health and Hospitals offers a competitive benefits package that includes:
- Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
- Retirement Savings and Pension Plans
- Loan Forgiveness Programs for eligible employees
- Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
- College tuition discounts and professional development opportunities
- Multiple employee discounts programs
