- Facilitate and document approximately 45 monthly Joint Operating Committee (JOC) executive sessions with key commercial and government payers
- Maintain partnership agreements
- Share policy updates received during JOC meetings with appropriate parties
- Act as the primary escalation lead and senior negotiator for complex, high-dollar claim disputes and denials across five multi-state regions
- Deploy advanced revenue integrity tactics to drive rapid variance resolution and maximum reimbursement
- Direct continuous auditing, triage, and monthly transmission of six specialized escalation logs
- Oversee vendor communication streams, including R1 RCM, to ensure systematic inventory clearance and high-dollar account compliance with Ascension revenue standards
- Direct and develop Senior Analysts
- Establish review standards for claim denial inquiries and escalation documentation criteria
- Manage daily task allocation across competing regional priorities
- Conduct structured monthly reviews on aged inventory discussed at JOC meetings
- Determine whether items should be sent to Legal or R1 RCM for next steps
- Maintain awareness of payer policy updates and contract provisions
Requirements
- Certified Coding Specialist (CCS) credentialed from the American Health Information Management Association (AHIMA) preferred
- Licensure required relevant to state in which work is performed
- High School diploma equivalency with 3 years of cumulative experience OR Associate's degree/Bachelor's degree with 2 years of cumulative experience OR 7 years of applicable cumulative job specific experience required
- 3 years of leadership or management experience preferred
- Advanced professional revenue cycle certification (e.g., CRCR, CSPR, or CSPPM) preferred
- Direct experience structuring and facilitating JOC or strategic payer-provider alignment frameworks
- Deep subject-matter expertise with major national and regional payer environments, including UHC, BCBS, Cigna, Aetna, and Humana
- Experience with vendor ecosystem integrations, including R1 RCM
Core Competencies
Demonstrates expertise in revenue cycle management, including advanced negotiation skills for high-dollar claim disputes and a strong understanding of payer environments. Proven ability to lead teams, manage complex projects, and ensure compliance with revenue standards.
Highest-signal resume keywords
- Certified Coding Specialist (CCS)
- Advanced Professional Revenue Cycle Certification
- Leadership Experience
- Joint Operating Committee (JOC) Facilitation
- Payer-Provider Alignment Frameworks
Hard Skills
- Revenue Cycle Management
- Claim Dispute Resolution
- Variance Resolution Tactics
- Auditing and Triage
- Escalation Documentation
- Inventory Management
- Payer Policy Awareness
- Contract Provisions Analysis
- Data Analysis
- Negotiation Skills
Soft Skills
- Communication
- Leadership
- Collaboration
- Problem-Solving
- Task Management
Certifications & Qualifications
- Certified Coding Specialist (CCS)
- Advanced Professional Revenue Cycle Certification
Industry Keywords
- Joint Operating Committee (JOC)
- Payer Environments
- UHC
- BCBS
- Cigna
- Aetna
- Humana
- Revenue Standards
- Compliance
- Healthcare Revenue Cycle
Tools & Technologies
- R1 RCM
- Escalation Logs
- Vendor Communication Systems
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Backend Revenue Cycle Manager Arbeitgeber: Jobtailor
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