Net Revenue Lead - PPG CBO

    Toledo, OH

    Job Description

    Being a part of a large family has advantages. With more than 500 ProMedica Physicians and advanced practice providers, our network is the region's most complete, with connections to leading hospitals and a wide spectrum of health services. ProMedica Physicians have locations serving northwest Ohio and Southeast Michigan, all working together with a single mission: the health of our communities.

    Position Summary

    The Net Revenue Lead of Revenue Integrity leads and provides direction to the Revenue Integrity Department. Lead responsibilities include oversight on all activities related to ProMedica's denial management, avoidable write-off reduction, and contract management processes. The Net Revenue Lead of Revenue Integrity ensures timely resolution of outstanding denials and reduces the volume of preventable write-offs and denials. Monitors underpayment recovery trends and provides feedback back to the necessary departments/payor contracting. Oversees the use of appropriate tools to identify denial and avoidable write off trends, maximize reimbursement opportunities, accelerate cash flow opportunities, and investigate underpayments. Develops best practices for reporting and other analytics to identify opportunities or problems, process improvements, and other system changes. Manages overall integrity of denial management and contract management and provides expertise to all analysts in developing on-going analytic tools including ad hoc queries and reports for members of the Revenue Cycle and Finance teams.

    In conjunction with Revenue Integrity Department as well as finance and clinical departments, the Net Revenue Lead assesses needs to proactively provide in-depth service and support, including discovering opportunities for denial prevention and utilization of standardized workflows; and participates in hiring and mentoring staff to support those functions. This position requires a high level of interpersonal skills to establish and enhance positive relationships with departments, co-workers, and others.

    Job Requirements

    • Bachelor's degree in Health Care Administration, Business, Accounting, Finance, or related field.
    • Excellent ability to understand and interpret statistical reports and perform quantitative analysis.Knowledge and understanding of insurance claim processing and third party reimbursement.
    • Knowledge of state and federal regulations as they pertain to billing processes and procedures.
    • Knowledge of the principles of Information Systems in order to effectively analyze and make decisions, ideally familiarity with the Epic system.
    • Knowledge of healthcare related financial and/or accounting practices.
    • Skill in effective oral, written, and interpersonal communication.
    • Skill in problem-solving in a variety of settings and translation of data into actionable steps.
    • Skill in time management and project management.
    • Ability to read, understand and interpret, analyze, and apply complex regulatory requirements.
    Additional Experience
    • Ability to work efficiently under pressure.
    • Ability to operate a computer and related applications.
    • Ability to apply appropriate supervisory, management, and leadership techniques in an operational setting.
    • Ability to work independently and take initiative.
    • Ability to demonstrate a commitment to continuous learning and to operationalize that learning.
    • Ability to deal effectively with constant changes and be a change agent.
    • Ability to deal effectively with difficult people and/or difficult situations.
    • Ability to willingly accept responsibility and/or delegate responsibility.
    • Ability to set priorities and use good judgment for self and staff.
    ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. It serves communities in 28 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines. The organization has more than 56,000 employees, 13 hospitals, 2,100+ physicians and advanced practice providers with privileges, 900+ healthcare providers employed by ProMedica Physicians, a health plan, and nearly 400 assisted living facilities, skilled nursing and rehabilitation centers, memory care communities, outpatient rehabilitation clinics, and hospice and home health care agencies. Driven by its Mission to improve your health and well-being, ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. For more information about ProMedica, please visit

    Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics.

    Equal Opportunity Employer/Drug-Free Workplace

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    On-call Requirements

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    Posting ID: 558405684Posted: 2020-05-22