Revenue Intelligence Manager

Job Requirements

Position Summary

The Manager, Revenue Intelligence reports directly to the Vice President of Strategic Finance and is responsible for system-level revenue optimization and will lead the organization in the development and implementation of a comprehensive revenue intelligence strategy. This position is a highly analytical, hands-on leadership role that demands a deep understanding of healthcare payment methodologies, revenue integrity, claims and revenue cycle processes, EHR functionality, health economics, financial reporting, and data analytics. The Manager will lead a team of analysts and collaborate with key internal stakeholders to develop revenue intelligence, perform complex economic modeling, and enhance margin.

Minimum Requirements

Education

• Bachelor's degree in Accounting, Finance, Computer Science, or any quantitative or applicable healthcare related field

Experience

• 5+ years healthcare experience with a specific focus in revenue, data analytics, decision support, managed care, or a related field
• Exceptional analytical, critical-thinking, and problem-solving skills
• Experience with complex economic models, actuarial analysis, statistics, or advanced financial analysis
• Expert knowledge of healthcare payment methodologies, rate structures, reimbursement, and revenue management
• Highly developed communication skills to effectively convey complex, detailed information clearly and concisely to internal customers, translating complex ideas into compelling, actionable recommendations
• Demonstrates systems-based thinking and able to identify trends to take advantage of opportunities to drive continuous improvement
• Ability to work independently, self-motivated, innovative, shows initiative, creative in overcoming obstacles, and results-focused

License/Registration/Certifications

• N/A

Preferred Requirements

Preferred Education

• Master's degree preferred

Preferred Experience

• 2+ years supervisory or management experience

Preferred License/Registration/Certifications

• N/A

Core Job Responsibilities

• Serves as the revenue intelligence subject matter expert for the organization, providing support to and collaborating with Reimbursement, Revenue Cycle, Payor Strategy, Net Revenue, Financial Planning and Analysis (FP&A), Operational Finance, and Regional Healthplus, LLC (Population Health division).
• Leverages knowledge of fee-for-service (FFS) and value-based (VB) reimbursement methodologies to identify synergistic opportunities & guide system-level revenue enhancement strategies.
• Develops tools and processes to effectively map the organization's comprehensive revenue landscape (IP, OP, Physician, Post-Acute, Value-Based Care, etc)
• Optimizes and leverages Epic expected payment calculations, RCA platform, and other data resources to enhance revenue mapping capabilities, improve yield, and drive performance improvement efforts.
• Responsible for Epic expected payment build, maintenance, and analysis.
• Collaborates with the Enterprise Intelligence and Analytics team to develop advanced data and analytics tools needed to support comprehensive revenue intelligence and more effectively leverage internal and external payment data.
• Identifies and leads cross-divisional improvement projects designed to address gaps and optimize revenue.
• Develops and maintains complex economic models including detailed revenue projections to evaluate financial impact and support strategic initiatives (e.g. new service lines, acquisitions, payor and case mix, strategic planning, cost-saving and revenue enhancement opportunities).
• Advances FFS and VB payment modeling techniques, performs what-if modeling based upon actuarial assumptions, and analyzes feasibility and/or impact of different payment methodologies and/or utilization patterns.
• Tracks, trends, and monitors revenue integrity and oversees development of appropriate expected payment KPIs.
• Translates complex payment methodologies and third-party payment performance issues into actionable business insights.
• Drives revenue intelligence and payment integrity business initiatives - coordinates with key stakeholders across divisions to identify and prioritize opportunities, provides decision support and project management to evaluate and advance solutions.
• Ensures organizational revenue reporting and analytics reflects revenue enhancing strategic priorities.
• Communicates revenue intelligence strategy and priorities to all key stakeholders, including operational and clinical leadership.
• Responsible for Strategic Pricing and Price Transparency.
• Oversees the maintenance of Employee Health Plan fee schedules.
• Supports FP&A in development of assumptions for annual operating budget and long-range financial plan.