Supervisor, Rev Cycle Systems (Resolute)

Position Overview

The Supervisor, Rev Cycle Systems (Resolute) manages the day-to-day operations of the Exact Sciences Laboratories Systems team. The Supervisor, Rev Cycle Systems' (Resolute) primary responsibilities include providing supervision, hiring, training, and coaching, managing workloads, and handling escalated concerns as related to revenue cycle systems and analytics. They will maintain accurate data reporting and be responsible for metrics and productivity measures, as well as any other key performance indicators. The Supervisor, Rev Cycle Systems (Resolute) will facilitate contract implementation and revenue pull-through activities, both proactive and reactive, with internal and external parties as needed. This position will ensure billing and payment processes are efficient, timely, and in compliance with corporate goals, contracts and/or regulations.

This position is remote.

Essential Duties

• Coach, mentor, and engage team members to increase overall performance.
• Assist in identification and reporting of system errors and workflow solutions.
• Oversee the creation and maintenance of payor and client master files to ensure accurate and timely updates or changes.
• Investigate and resolve electronic remittance errors.
• Drive operational excellence of order entry and exception handling processes; including process flow, data integrity, information alignment, and continual process improvement.
• Support and Lead cross-functional initiatives across multiple departments.
• Act as a liaison between other functional areas within Exact Sciences Laboratories.
• Collaborate with team leadership and support the day-to-day team operations.
• Lead the development and maintenance of a contract database and contract management system, working with the credentialing and legal teams.
• Collaborate with finance and analytics to identify, analyze, and determine next steps to address negative revenue pull-through scenarios specific to payers and across payer segments, including Medicare Advantage, Blues, Medicaid, etc.
• Collaborate with RCT Managers to develop and leverage relationships with billing operations staff and payers when resolving claim adjudication issues, both contractual and non-contractual.
• Support execution of pull-through plans to meet quarterly revenue goals.
• Facilitate conversations with appropriate Exact personnel early in the contracting process to provide an overview of the account to avoid delay in implementation down the road.
• Report and suggest system changes to Revenue Cycle Leadership and Revenue Cycle staff as needed.
• Work closely with vendor and payor partners to identify and resolve systematic issues.
• Provide systematic support to ensure timely electronic submission of claims, including subscriber ID format, Z-code requirements, etc., based on payor and contractual requirements.
• Work directly with Client Support and Implementation Services (CSIS) teams to ensure accurate and timely client implementations as concerns the revenue cycle.
• Develop and oversee processes and procedures for the efficient and successful flow of interdependent information between the third-party billing vendor, the receivables department, and Exact Sciences’ contact center.
• Assist in the oversight of maintenance and updates regarding software vendor changes.
• Provide escalation support to staff.
• Takes part in the creation of training and Standard Operating Procedures (SOP) materials as appropriate; identifies additional training needs/resources as needed.
• Provide guidance on priorities for the department; ensures work is completed in a timely and accurate manner.
• Assist with recruiting, hiring, onboarding, coaching, and counseling of department staff.
• Supervise staff; including, but not limited to, organize and prioritize work, write/conduct performance reviews, train/develop, and manage work performance.
• Communicate goals clearly to employees to ensure understanding and success in achieving them.
• Ensure that appropriate training opportunities are identified and provided to employees to grow personal, career, and organizational development capabilities.
• Promote a team-oriented environment that fosters effective collaboration within and outside of the department.
• Provide on-going coaching to staff to ensure a consistent level of service is maintained.
• Provide input and guidance in the identification of updates needed to standard operating procedures (SOPs), communications of official guidance (COOGs), workflow, or documentation in collaboration with operational leaders and in accordance with all regulatory practices.
• Respond to technical questions consistent with level of training; seek guidance appropriately if answers are not known.
• Coordinate, develop, implement, and performs competency assessments or proficiency testing, as necessary.
• Monitor associates and overall department metrics to ensure revenue cycle systems functions are addressed according to company/department goals.
• Supervise staff through prioritization and organization of work, writing/conduct performance reviews, training/developing training expertise, and managing work performance.
• Apply excellent interpersonal skills and the ability to interact and build strong working relationships with internal clients and key stakeholders as well as peers at all levels of the organization.
• Ensure compliance with all Company procedures and guidelines; including, but not limited to, Code of Business Conduct and Ethics.
• Maintain confidentiality in compliance with HIPAA regulations and ensures that department remains compliant with all relevant regulations.
• Ability to successfully manage multiple priorities/projects at one time; ability to handle pressure of deadlines and complex issues in an effective way.
• Ability to create and maintain logs/charts in an accurate, organized, and effective manner.
• Strong analytical, critical thinking, and forecasting skills.
• Excellent written and verbal English communication skills and the ability to professionally communicate with vendor partners.
• Ability to work independently.
• Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
• Support and comply with the company’s Quality Management System policies and procedures.
• Regular and reliable attendance.
• Ability to work normal schedule of Monday through Friday during normal business hours.
• Ability to work in front of a computer screen and/or perform typing for approximately 80% of a typical working day.
• You will be required to successfully complete an assessment showing understanding of Exact Sciences Epic processes necessary to the job functions with a score of 80% or higher. Exact Sciences will make a reasonable accommodation available, if necessary, to assist an employee with a disability to satisfy this requirement.

Minimum Qualifications

• Bachelor’s degree in Information Systems, Finance, Business, or related field; or High School Degree/General Education Diploma and 4 years of relevant experience in lieu of Bachelor’s degree.
• 3+ years of experience in the medical revenue cycle function to include third party payer experience.
• 3+ years of experience working in the medical/healthcare billing area; with strong, demonstrated knowledge of Epic Resolute systems.
• 3+ years of experience working with a third-party billing service provider or revenue cycle management software.
• 2+ years of experience in a position with responsibility leading direct reports, including leadership roles.
• 5+ years of experience working in a customer service environment specialized in providing an exceptional customer experience.
• Demonstrated knowledge of medical coding including International Classification of Diseases (ICD-9) and (ICD-10) and Coding Procedure Terminology (CPT) and HCPCS coding.
• Demonstrated knowledge of Explanation of Benefits (EOB); must be able to read and interpret explanation of benefits (EOB) for all payers.
• Demonstrated understanding of ASC X12 (ANSI) claims adjustment and remark codes.
• Knowledge and familiarization with Medicare billing regulations and reimbursement methodologies.
• Authorization to work in the United States without sponsorship.
• Demonstrated understanding of content development, facilitation, and evaluation of training.
• Demonstrated understanding of working in customer service, billing, data entry, or healthcare related field.
• Demonstrated ability to plan workload, allocate tasks, and scale operations to align with business priorities.
• Strong computer skills to include internet navigation, use of virtual meeting/facilitation platforms, use of messaging services, and use of Microsoft Office programs.
• Demonstrated ability to perform the Essential Duties of the position with or without accommodation.
• You must maintain all certification requirements as deemed necessary.

Preferred Qualifications

• Leadership in accounts receivable or billing operations.
• Experience working in the insurance industry.
• CPC, CPAM, or similar certification.
• Epic Resolute Certification.
• Membership in any of the patient accounting organizations (e.g. AHAM) or industry organizations (e.g. HFMA) is encouraged.