Facility: VIRTUAL-GA

Job Summary:

The Director Contract Build & Modeling leads Contracts Build and Modeling management team responsible for WellStar Health System (WHS) payor contract builds, modeling, integration, and coordination from request to approval and into production. This position reports to the Executive Director of Revenue Cycle HB A/R Management. This role serves as a revenue cycle expert for WHS migration, integration, and modeling of payor contracts into EPIC contract management platform. He/she advises and directs management staff on higher level decisions or problem resolution to support payment variance contract assessments, quality assurance, build investigation, contract integration, and operational contract interpretation. In addition, he/she has staff management oversight for evaluating system build and reconciliation process to ensure accurate contractual are taken at the time of billing per the analysis, review, and maintenance of WHS's Contract Management applications as outlined in the payor contract language. This Director is responsible for managing various department reports, both ad-hoc and routine, to assist in the identification of payment variance opportunities and other payment irregularities. He/she works with the managed care department with the build and modeling of contract proposals, including what-if scenarios, to demonstrate potential reimbursement, opportunities and/or shortfalls. The Director Contract Build and Modeling ensures WHS patient accounts have an accurate expected reimbursement per the managed care contract language and system build. This leader also works directly with managers in managing vendor partners and act as vendor liaison to reduce revenue leakage from WellStar. This leader is a key member of the team to support financial stewardship within WellStar Health System

Core Responsibilities and Essential Functions:

Responsible for day to day operations of the Contracts Modeling, Integration and Build department.

- Manage the daily operations of the Contracts Build and Modeling
- Manage the resolution of all contracts build, correction, and modeling in an efficient, timely, and professional manner.
- Direct managers responsible for staff that build, model, and integrate contracts into applicable I.T. systems
- Manages staff responsible for the process of interpreting and loading complex payer contracts into the WHS Contract Manager production system(s) to enable the system to accurately net down accounts receivable at the time of final bill
- Provide high level decision making on complex contracts interpretation, model, and reimbursement issues
- Monitor the current standards of productivity and quality expectation for all staff.
- Maintain a strong knowledge base of reimbursement procedures of third party and private insurance payers, state and federal regulations, and local regulations relating to insurance and private collections.
- Facilitate regular staff meetings to communicate departmental and organizational issues, goals, achievements, and changes.
- Select, evaluate, counsel, and discipline as required in a positive manner consistent with medical center Policies
- Maintain a system to informally and formally recognize staff for accomplishments.
- Demonstrate excellent customer service through oral and written communication.
- Meet the current standards of productivity and quality expectations as set forth by management.
- Aid in the development of the department’s annual operating budget, maintain responsibility for the department operating within the assigned budget
- Participate in the testing of assigned software upgrades and programs, and ensure the staff has the appropriate and applicable access to and training on software programs.
- Serve as a role model and mentor to co-workers and team members.
- Oversee and ensure the completion of all employee paperwork and files, including the accurate and timely completion of payroll, employee evaluations, leaves of absence, Worker’s Compensation, and employee education files
- Perform other duties and responsibilities as assigned. Operational Systems Management, Maintenance, Support and Development

- Responsible for coordinating the maximization of revenue cycle systems and all other computer applications currently used by, or which affect the efficiency of the contracts modeling and build.
- Competency evaluation and testing of updates and system implementations /or enhancements
- Define and address where delays and backlogs may be occurring in the contracts integration and build
- Responsibility for revenue cycle service assigned education, maintenance and support functions through the integrated workgroup and service center. Contract Management, Net Revenue Estimation and Modeling

- Responsible for revenue cycle contract management, build, modeling and supporting technologies for Net Revenue evaluation and patient estimation technology platforms.
- Ensure accuracy of net revenue contract modeling
- Develop key performance indicators, including contract accuracy, turn-around -time for contract creation (Build, Validation, QA and Post Production auditing).

Required Minimum Education:

Bachelor's Degree in business, healthcare, related field or
Master of Business Administration, or another related field Preferred.

Required Minimum License(s) and Certification(s):

Additional Licenses and Certifications:

Required Minimum Experience:

Minimum 5 years experience in Revenue Cycle Management, healthcare contracts build and modeling, healthcare reimbursement experience. Required

Required Minimum Skills:

Epic knowledgeable, Microsoft Office, excellent communication skills, experience in quality control and training preferred.
Experience in project management desired.
Demonstrate proficiency in creating monthly Key Performance Indicators
Demonstrate proficiency in understanding monthly Key Performance Indicators
Create and studies revenue reports/Key Performance Indicators and makes recommendations relative to revenue cycle processes for optimization
Demonstrate proficiency in locating and interpreting contract verbiage for timely claims resolution
Demonstrate proficiency in contract management and expected reimbursement technology
Demonstrate knowledge of billing rules and coverage for all Major Payors
Identify where to locate and review state and federal regulations as they relate to all payers
Create work queue management report for assigned work queues
Post adjustments at time of account review
Create/update department policies and procedures
Apply appropriate supervisory, management and leadership techniques in an operational setting
Evaluate best practices suggestions for possible into the revenue cycle