Job Requirements Position SummaryThe Manager, Revenue Intelligence reports directly to the Vice President of Strategic Finance and is responsible for system-level revenue optimization and will lead the organization in the development and implementation of a comprehensive revenue intelligence strategy. This position is a highly analytical, hands-on leadership role that demands a deep understanding of healthcare payment methodologies, revenue integrity, claims and revenue cycle processes, EHR functionality, health economics, financial reporting, and data analytics. The Manager will lead a team of analysts and collaborate with key internal stakeholders to develop revenue intelligence, perform complex economic modeling, and enhance margin.
Minimum RequirementsEducation- Bachelor's degree in Accounting, Finance, Computer Science, or any quantitative or applicable healthcare related field
Experience - 5+ years healthcare experience with a specific focus in revenue, data analytics, decision support, managed care, or a related field
- Exceptional analytical, critical-thinking, and problem-solving skills
- Experience with complex economic models, actuarial analysis, statistics, or advanced financial analysis
- Expert knowledge of healthcare payment methodologies, rate structures, reimbursement, and revenue management
- Highly developed communication skills to effectively convey complex, detailed information clearly and concisely to internal customers, translating complex ideas into compelling, actionable recommendations
- Demonstrates systems-based thinking and able to identify trends to take advantage of opportunities to drive continuous improvement
- Ability to work independently, self-motivated, innovative, shows initiative, creative in overcoming obstacles, and results-focused
License/Registration/Certifications Preferred RequirementsPreferred Education - Master's degree preferred
Preferred Experience - 2+ years supervisory or management experience
Preferred License/Registration/Certifications Core Job Responsibilities- Serves as the revenue intelligence subject matter expert for the organization, providing support to and collaborating with Reimbursement, Revenue Cycle, Payor Strategy, Net Revenue, Financial Planning and Analysis (FP&A), Operational Finance, and Regional Healthplus, LLC (Population Health division).
- Leverages knowledge of fee-for-service (FFS) and value-based (VB) reimbursement methodologies to identify synergistic opportunities & guide system-level revenue enhancement strategies.
- Develops tools and processes to effectively map the organization's comprehensive revenue landscape (IP, OP, Physician, Post-Acute, Value-Based Care, etc)
- Optimizes and leverages Epic expected payment calculations, RCA platform, and other data resources to enhance revenue mapping capabilities, improve yield, and drive performance improvement efforts.
- Responsible for Epic expected payment build, maintenance, and analysis.
- Collaborates with the Enterprise Intelligence and Analytics team to develop advanced data and analytics tools needed to support comprehensive revenue intelligence and more effectively leverage internal and external payment data.
- Identifies and leads cross-divisional improvement projects designed to address gaps and optimize revenue.
- Develops and maintains complex economic models including detailed revenue projections to evaluate financial impact and support strategic initiatives (e.g. new service lines, acquisitions, payor and case mix, strategic planning, cost-saving and revenue enhancement opportunities).
- Advances FFS and VB payment modeling techniques, performs what-if modeling based upon actuarial assumptions, and analyzes feasibility and/or impact of different payment methodologies and/or utilization patterns.
- Tracks, trends, and monitors revenue integrity and oversees development of appropriate expected payment KPIs.
- Translates complex payment methodologies and third-party payment performance issues into actionable business insights.
- Drives revenue intelligence and payment integrity business initiatives - coordinates with key stakeholders across divisions to identify and prioritize opportunities, provides decision support and project management to evaluate and advance solutions.
- Ensures organizational revenue reporting and analytics reflects revenue enhancing strategic priorities.
- Communicates revenue intelligence strategy and priorities to all key stakeholders, including operational and clinical leadership.
- Responsible for Strategic Pricing and Price Transparency.
- Oversees the maintenance of Employee Health Plan fee schedules.
- Supports FP&A in development of assumptions for annual operating budget and long-range financial plan.
