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Manager, RCM - Chicago Illinois
Company: Tempus AI Inc.
Location: Chicago, Illinois
Posted On: 11/02/2024
Passionate about precision medicine and advancing the healthcare industry?
Recent advancements in underlying technology have finally made it possible for AI to impact clinical care in a meaningful way. Tempus' proprietary platform connects an entire ecosystem of real-world evidence to deliver real-time, actionable insights to physicians, providing critical information about the right treatments for the right patients, at the right time.
Position Overview:
Tempus is seeking a Revenue Cycle Manager with a strong focus on Post-Payment Appeals, Refunds, Audits, and Payer Relations to lead our dynamic team. This critical role encompasses the management of post-payment appeals, the development of refund policies, and the meticulous handling of payer audits. The ideal candidate will possess a background in revenue cycle management, complemented by paralegal expertise that is instrumental in navigating the complexities of audit documentation, research, and communication. A strategic mindset and robust leadership skills are essential for driving process optimization and ensuring compliance with payer requirements.
Key Responsibilities:
Post-Payment Appeals & Refunds
Manage the Tempus refunds and post-payment appeals team with a focus on continuous improvement and excellence.
Develop and implement robust policies and procedures to ensure timely and accurate issuance of refunds where appropriate.
Establish and monitor Key Performance Indicators (KPIs) to track and improve the efficiency and effectiveness of the post-payment appeals process.
Create and maintain Standard Operating Procedures (SOPs) for the post-payment appeals team, ensuring compliance with all regulatory guidelines and payer requirements.
Provide comprehensive feedback to management on trends, findings, and strategies for resolving issues with both in-network and out-of-network payers.
Lead initiatives to identify root causes of overpayments and implement proactive measures to reduce the occurrence of future refunds.
Payer Audit Management
Oversee the collection and organization of all necessary documentation in response to payer audits, ensuring meticulous documentation management.
Conduct thorough research to support audit responses and appeals.
Serve as the primary point of contact for all audit-related inquiries and correspondence, including writing clear, concise, and persuasive appeal response letters.
Collaborate with external auditors and payer representatives, providing timely responses and addressing any queries or concerns effectively.
Communicate effectively with clients and stakeholders regarding audit processes and outcomes.
Work closely with relevant departments to address audit findings and implement corrective actions.
Requirements:
Bachelor's degree in healthcare administration, business, or a related field (or equivalent experience).
Familiarity with healthcare reimbursement, payer policies, and regulatory compliance in the revenue cycle.
Strong paralegal skills, including documentation management, legal research, and client communication, are highly desirable.
Excellent written communication skills, with the ability to produce clear, concise, and persuasive documents.
Strong attention to detail and the ability to prioritize multiple competing tasks across projects, Third Party Billing Vendor, and internal Tempus teams.
Proven track record of establishing and monitoring KPIs and SOPs within a revenue cycle context.
Creative mindset in order to problem solve, comfort with ambiguity, and confidence to ask key questions.
Ability to develop and maintain strong relationships across departments (Market Access, Finance, Legal, Product, Medical Affairs, Lab Ops, etc.).
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