Sr. Manager, Revenue Integrity

OneOncology is positioning community oncologists to drive the future of cancer care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer. Our team is bringing together leaders to the market place to help drive OneOncology’s mission and vision.

Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of community oncologists and the patients they serve.

Job Description:

The Sr. Manager, Revenue Integrity is responsible for the performance of all activities related to and necessary to successfully resolve or facilitate resolution of healthcare claims under or over-paid to contracted payment terms, as well as identification of claims qualifying for additional reimbursement under other alternate reimbursement methodologies, to secure additional reimbursement related to high-cost outlier medical claims. The Sr. Manager will research, analyze, document, facilitate appeal, reconcile, prepare trend analytics, prepare monthly management reporting and bring to successful closure all assigned third party payer accounts underpaid or unpaid through assertive, effective and timely appeal processes, procedures and efforts contributing to the successful practice-by-practice performance in the achievement of best practice levels of net revenue recovery.

Responsibilities

• Design and implement processes, technologies, KPIs, reporting, and meeting structures to proactively identify variances to contracted rates or other payment agreements.
• Create and implement a program incorporating existing and new technology for contract modeling, work listing/workflow, and reporting to support the contract variance program.
• Create reports specific to individual practices, regions, and payers.
• Collaborate with a variety of stakeholders, including the OneOncology Managed Care/Contracting department, practice-specific managed care/contracting resources or vendors, legal teams, revenue cycle operations teams, IT teams, and others to accomplish goals, share information, and make business decisions.
• Support vendor contract negotiations by producing context on underpayment rates, current issues, and qualitative information about the timeliness and responsiveness of payers to issues.
• Support each practice in their payer/provider rep calls, including providing a holistic and complete summary of all contract variance issues, underpayment issues, and other issues as supported by the reporting, processes, and teams outlined above.
• Manage relationships with relevant vendors and/or establish new relationships with vendors to support the goals of the team as needed.
• Implement and maintain charge master update process for all practices, utilizing best practice methodology. Develop process to identify charges below fee schedules.
• Investigate and identify root causes to effectively quantify and prioritize issues for resolution or escalation.
• Effectively communicate by summarizing technical details into business impacts, creating clear messages for leadership to understand and assist with issue resolution as needed.
• Participate in the design of an enterprise-wide contract variance and management strategy including advising on the best-in-class technology solutions, resources needed, and organizational structure.
• Work high priority/urgent variances on an escalation basis.
• Produce financial reporting to assist finance teams in estimating and incorporating the impact of variances as well as the impact of resolution of variance issues.
• Design and implement continuous improvement methods including training, education, process changes, quality measures; establish and measure KPIs to ensure that progress is made towards goals.
• Prepare for and support internal and external audits related to payment variances, providing necessary documentation and insights.
• Develop and direct team to deliver training to avoid upstream issues that are causing downstream variances/impacts.
  
  

Qualifications

• 5 years minimum in revenue integrity, contracts and underpayments, or another related role.
• Requisite technical knowledge to accomplish all role expectations.
• Bachelor's degree in a relevant field or equivalent experience required.
• Strong relationship building and collaboration skills with proven impact driving cross-functional projects and outcomes.
• Strong communication skills, proven ability to collaborate across multi-functional teams.
• Ability to operate effectively in a collaborative, shared leadership environment.
• Willingness to travel as needed (approx. 25%)