Sr. Mgr. Commercial Revenue Integrity

Sr. Manager, Commercial Revenue Strategy & Integrity (CSI) will be the subject matter expert and resource, in collaboration with Managed Care and Legal, on the interpretation of payor contract and benefit language to identify, escalate, and trend ‘true’ payment variances and alert of risks associated with (APD). These hand-selected individuals have strong critical thinking and payor context to timely route to RCM for dispute/appeal while escalating for legal action, as necessary. Key Areas Include:

Underpayments and Denials: CSI identifies root cause of payment variances related to contract compliance and routes to RCM for dispute. In parallel, notifies Managed Care and Legal once any issue reaches $25K.

Indicators of Suspicious Behavior of TPAs/Plans: Serves as gatekeeper to review and approve all requests for removal of network plan Reviews and approves requests for discounts or exceptions to network fee schedule

Other duties include:

Manage the tactical execution of short- and long-term objectives through the coordination of activities with a direct responsibility for results, including costs, methods, and staffing.

• Oversee ongoing operations within the assigned function(s); ensuring compliance with all applicable company policies and procedures.
• Identify, develop and implement policies and procedures to maximize the efficacy and efficiency of operations within the assigned function(s).
• Act as an SME; serving as a resource and liaison to cross-divisional teams by establishing and maintaining strong working relationships through open communication and productive collaboration on diverse issues as they affect the assigned business unit(s).
• May manage the generation and distribution of diverse reports within the assigned function(s) on a routine basis; ensuring data accuracy and integrity in a timely manner.
• May drive the development and implementation of tools and/or processes that enable high level analyses to monitor the impact of revenue process changes for the assigned business unit(s).
• Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations.
• Ensure all employees within the assigned team(s) understand and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations; establishing and maintaining effective internal systems and controls to promote compliance.
• Provide leadership, coaching and development plans for all direct reports to maintain an engaged and productive workforce; partnering with Human Resources on employee matters.
• Provide technical guidance.
• Assist with various projects as assigned.
• Other duties as assigned.

PURPOSE AND SCOPE:

The Sr Manager, Revenue Analytics manages, prepares, administers, and directs the control of the revenue analytics activities and team(s) within the assigned function(s). The incumbent reviews and approves recommendations for financial planning and control, providing relevant fiscal information to management. The Sr Manager, Revenue Analytics is responsible for selecting, developing, and evaluating the team(s) to ensure the efficient operation of the function(s).

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Manage and lead the tactical execution of short- and long-term objectives through the coordination of activities with a direct responsibility for results, including costs, methods, and staffing.
• Manage the coordination and completion of diverse monthly processes.
• Lead the development and implementation of strategic plans, annual forecasts, business plans, cost analyses, budgets, and financial processes for assigned business unit(s); providing ad hoc analyses as necessary.
• Lead process reviews, business process analyses, risk reviews, and internal control monitoring to ensuring compliance with the specifications of the Sarbanes-Oxley Act (SOX) within assigned function(s).
• Subject Matter Expert and liaison for cross-divisional teams and management.
• Provide leadership, coaching and development plans for all direct reports to maintain an engaged and productive workforce; partnering with Human Resources on employee matters.
• Provide technical guidance.
• Assist with various projects as assigned.
• Other duties as assigned.

Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions. 

PHYSICAL DEMANDS AND WORKING CONDITIONS:

The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SUPERVISION:

May be responsible for the direct supervision of various levels

EDUCATION:

Bachelor's Degree required; Advanced Degree desirable.

EXPERIENCE AND REQUIRED SKILLS:

• 6 - 8 years' related experience.
• 3+ years' experience as a Manager preferred.
• Demonstrated ability to manage one or more departments.
• Strong computer skills with advanced proficiency in word processing, spreadsheet, database, presentation and email applications.
• Ability to work in a fast-paced environment with changing priorities and client conditions.
• Strong time management skills with the ability to multitask concurrent priorities in an organized manner.
• Self-starter with the ability to work independently under minimal supervision.
• Strong interpersonal skills to effectively lead cohesive and productive teams.
• Proactive management style with creative problem-solving skills.
• Excellent oral and written communication skills to effectively communicate with all levels of management.

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.