Manager Revenue Cycle Operations

About the Role

The Manager of Revenue Cycle Operations oversees contract modeling, reimbursement analytics, contract management systems, and payer performance analysis. This position leads the development and implementation of best-practice processes supporting accounts receivable valuation, reimbursement optimization, contract compliance, and revenue cycle performance improvement. The Manager collaborates closely with Revenue Cycle and Managed Care leadership to drive decision-making, optimize contractual reimbursement, and ensure operational excellence.

Responsibilities

• Manages and mentors contract management, Hospital’s Joint Operating Committee (JOC), and analytics staff.
• Develops contract models to support payer contract negotiations.
• Analyzes proposed contract amendments and payer policy changes to quantify financial impact.
• Builds and maintains payer contracts in contract management systems.
• Coordinates the team dedicated to ensuring reimbursement calculation accuracy.
• Provides detailed reports to the Managed Care department on systemic underpayment issues, accounts associated with payer policy disputes, contract rate modeling, CDM price change analysis compared to contract rates, and other relevant topics.
• Prepares data analysis for Revenue Cycle and Managed Care Contracting leadership, clearly conveying trends and identifying key areas for revenue and contract optimization and operational performance improvement.
• Monitors and tracks ongoing payer performance through key performance indicators (KPI) in comparison to industry benchmarks.
• Directs the efforts of the JOC teams tasked with resolving contested accounts receivable and driving settlement.
• Audits staff’s work and participates in developing and delivering training programs within the department.
• Creates system and process audit plans, resolves discrepancies, and recommends necessary fixes.
• Troubleshoots issues, resolves concerns, and advises management of results and recommended actions.
• Creates reports to evaluate accounts receivables and business outcomes.
• Cultivates effective collaborative relationships with departmental teams to seek resolution of payer contract and reimbursement issues.
• Maintains expert knowledge of Medicare, Medicaid, and Commercial reimbursement, staying abreast of group payer contracts, payer policies, payer plans, and member benefits.
• Keeps apprised of rules and regulations affecting reimbursement.
• Manages special projects and duties as assigned.
• Leads the analysis, implementation, and maintenance of revenue cycle best practice processes and activities.

Requirements

• Bachelor’s Degree and 5 years of revenue cycle, reimbursement analytics, contract management, or managed care experience. In lieu of a bachelor’s degree, at least 9 years of relevant experience is required.
• Proficient in MS Office Suite, including Excel (Power Query, BI), Word, Access, Visio, and PowerPoint.
• Knowledge of Invision Patient Accounting, Contract Management, and/or Claims Scrubber software.
• Experience reporting from healthcare decision support, patient accounting, contract management, and/or claims scrubber systems.
• Knowledge of CPT, HCPCs, and ICD-10 coding principles.
• Expert knowledge of inpatient and outpatient billing requirements (UB-04, 837i), specifically how claims information impacts and drives reimbursement.
• Expert knowledge of Medicare, Medicaid, and Commercial reimbursement methodologies.
• Intermediate to advanced proficiency in SQL or Database reporting queries.
• Demonstrated analytical skills, with the ability to break down and quantify problems and processes.
• Excellent written and verbal communication skills.
• Demonstrated ability to manage processes and timelines effectively.

Preferred Qualifications

• Master’s degree in accounting or finance, health information management, health administration, computer science, or a related field.
• Medical Coding Certification through the American Academy of Professional Coders (AAPC) and/or the American Health Information Management Association (AHIMA).
• Revenue cycle supervisory or managerial experience.

Verification of degree (e.g., diploma or official transcript) is required for this role. Upload of documentation must be included with your application for consideration.

Special Notes

• This position will remain posted until filled or for a maximum of 90 days. An initial review of all applicants will occur two weeks from the posting date.
• Prior to the start date, the selected candidate must meet the following requirements:
  • Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine’s Employee Health Services.
  • Complete electronic reference check with a minimum of three (3) professional references.
  • Successfully complete a 4-panel drug screen.
  • Meet regulatory requirements for pre-employment screenings.
  • Provide a copy of any required New York State license(s)/certificate(s).
• Failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.
• Stony Brook Medicine is a smoke-free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas.
• This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
• This function/position may be designated as “essential,” requiring employees to remain at their work location or report to work during institutional emergencies.

Pay

The anticipated pay range for this position is $xxx - $xxx per year. The specific salary offer will be based on the candidate’s validated years of comparable experience. Some positions offer annual supplemental pay, such as location pay for UUP full-time positions ($4,000).

Benefits

Your total compensation goes beyond the number in your paycheck. Stony Brook University Hospital provides generous leave, health plans, and a state pension that add to your bottom line.