Manager of Payment Integrity - Revenue Integrity/CDM

McLeod Health; Florence (SC); On-site; USD 75,000 - 110,000; Full time

Job summary

McLeod Health in Florence, SC seeks a seasoned revenue integrity professional to supervise contract auditors and appeals staff, coordinate training, and support contract negotiations. The role drives performance in managed care operations and ensures compliant reimbursement across departments.

The ideal candidate will have 3+ years in revenue cycle management, strong analytical and communication skills, and experience with Epic Resolute Hospital and Professional Billing.

Qualifications

• Experience in provider-based managed care or denials management is required.
• Knowledge of managed care terminology and reimbursement methodologies.
• Experience with Patient Financial Services applications is preferred.

Responsibilities

• Supervise Managed Care Contract Auditors and Appeals staff; coordinate workloads and training.
• Support managed care contract negotiations and monitor financial performance.
• Oversee daily operations of the managed care compliance system, including denials and underpayments.
• Coordinate research of employer health plan information for internal departments.
• Participate in organizational projects as assigned by senior leadership.

Skills

Managed care

Revenue cycle

Analytical skills

Communication skills

Education

Bachelor's Degree

High School Diploma

Tools

Epic Resolute

Job description

Job Description

• Maintains a professional image and exhibits excellent customer relations to patients, visitors, physicians, and co-workers in accordance with our Service Excellence Standards and Core Values. Keep the Service Excellence statement as first item.
• Exercises direct supervision of Managed Care Contract Auditors, DM Appeals Coordinators, and Appeals Specialists. Coordinates workloads, interviews, hires, and trains new employees. Evaluates and counsels employees on work performance and attendance, recommends merit increases, promotions, and terminations.
• Provides support to the managed care contract negotiation process.
• Works with Senior Managed Care Analysts to monitor and report managed care contract financial performance.
• Oversees the daily operations of the managed care compliance system including underpayments and denials management, as well as contract management and compliance operations.
• Responsible for formal dispute initiatives with managed care payors.
• Provide dedicated managed care support to other hospital departments as well as Physician Practices, Home Health, and Hospice.
• Participate and coordinate organizational meetings with contract payers.
• Coordinate research of employer health plan information.
• Provide service/code-specific managed care reimbursement as requested by internal departments.
• Participate in other organizational projects as assigned by Director of Revenue Integrity – Corp, AVP of Revenue Optimization and Single Billing Office, Vice-President of Business Operations, or Chief Financial Officer.
• Coordinates the timely appeal of all third-party denials and underpayments.

Work Schedule:

80 hours bi-weekly

Qualifications /Training:

• Three years experience in provider-based managed care, patient financial services, or denials management operations.
• Experience in analyzing managed care reimbursement methodologies.
• Comprehensive knowledge of managed care terminology.
• Working knowledge of Patient Financial Services applications.
• Procedural knowledge of hospital and physician practice accounts receivable management.
• Ability to analyze business problems and opportunities and provide effective practical solutions while focusing on continuous improvement and innovation
• Excellent verbal and written communication skills

Licenses/Certifications/Registrations/Education:

Bachelors Degree or 3 years management experience within the Revenue Cycle preferred. High School Diploma with 5 years experience within Revenue Cycle required.

Preferred Experience:

Epic Experience in Resolute Hospital and Professional Billing – 2 years

About Us:

Founded in 1906, McLeod Health is a locally owned and managed, not for profit organization supported by the strength of more than 900 members on its medical staff and more than 2,900 licensed nurses. McLeod Health is also composed of approximately 15,000 team members and more than 90 physician practices throughout its 18-county service area . With seven hospitals, McLeod Health operates three Health and Fitness Centers, a Sports Medicine and Outpatient Rehabilitation Center, Hospice and Home Health Services. The system currently has 988 licensed beds , including Hospice and Behavioral Health. The hospitals within McLeod Health include: McLeod Regional Medical Center, McLeod Health Dillon, McLeod Health Loris, McLeod Health Seacoast, McLeod Health Cheraw, McLeod Health Clarendon and McLeod Behavioral Health.

About The Team:

If you would enjoy working in a dynamic environment and are looking for an opportunity to become part of a stellar team of professionals,

We are an equal opportunity employer.