CCMC Denials, Payment Review & Transplant Manager (Manager, Patient Business Services)

Leads directs and implements operational tactics for the CCMC Denials Payment Review and Transplant units driving efficient revenue cycle management across denial resolution payment review and transplant billing/follow-upincluding specialized cellular gene therapyfor OHSU and all current/future system partners; CCMC encompasses Commercial Contract and Managed Care accounts.

Direct Management and Supervision

• Oversees the OHSU Health CCMC Denials Payment Review and Transplant units ensuring seamless operations and high performance across all functions.
• Monitors follow-up worklists and develops action plans to achieve weekly billing and follow-up work-in-progress (WIP) goals.
• Provides strategic leadership to guide departmental operations effectively.
• Establishes goals and objectives to foster a collaborative high-performing and supportive team environment.
• Recruits motivates and coaches staff to drive exceptional performance and professional growth.
• Ensures staff are equipped with adequate training resources and information to execute their responsibilities.
• Resolves issues related to personnel patient accounts and organizational priorities exercising sound judgment.
• Maximizes use of Aeos and Aeos Analytics to optimize unit performance and outcomes.
• Completes all tasks on the manager checklist (daily weekly monthly) to maintain operational rigor.
• Ensures all CCMC Denial Payment Review and Transplant account representatives adhere to standardized response guidelines including defined pend times to ensure consistency and efficiency.

Administrative Leadership

• Provides strategic direction for the OHSU Health CCMC Denials Payment Review and Transplant units to ensure efficient revenue cycle operations.
• Routinely monitors and reports on unit performance against established targets ensuring transparency and accountability.
• Achieves standard performance metrics or develops targeted action plans to meet benchmarks effectively.
• Develops and maintains comprehensive department policies and procedures to support operational consistency compliance and excellence.

Operational Oversight and Optimization

• Supports the OHSU Health CCMC Denials Payment Review and Transplant units by driving operational excellence and efficiency.
• Monitors department activities identifying issues and recommending solutions to resolve problems and prevent recurrence.
• Reviews and refines procedures to enhance efficiency minimize billing delays and expedite account resolution.
• Analyzes and reports on operational trends to inform strategic improvements.
• Collaborates across teams to optimize workflows streamline billing processes and improve individual and overall accounts receivable performance.
• Communicates effectively with all Patient Business Services (PBS) staff to provide support and ensure high-quality service delivery.
• Presents complex information clearly and tailored to diverse audiences including staff management and external stakeholders.

Support for Internal Stakeholders

• Delivers high-quality assistance to PBS internal customers including Patient Access Services (PAS) Managed Care Contracting Professional Billing (PB) and Healthcare Financial Services (HFS).
• Leverages key staff expertise to ensure all information provided by PBS is accurate complete and responsive to stakeholder needs.

Other duties as assigned.

• Bachelors degree in healthcare administration business or related field.
• 5 Years of progressive supervisory experience to include recruitment termination and discipline of personnel.
• 5 years of hospital billing management and automated systems experience.
• 3 years of current Medicare and Medicaid program knowledge and experience (within the last 3 years).
• Comprehensive knowledge of payor networks requirements and reimbursement methodologies including APCs DRGs CPT HCPCS ICD-10 coding and modifiers.
• Strong leadership skills to foster team development consensus-building and effective supervision of multiple staff and priorities in a complex environment.
• Exceptional verbal and written communication skills to convey complex information to diverse audiences.
• In-depth understanding of healthcare industry financial and statistical indicators.
• Working knowledge of clinical and coding aspects of the revenue cycle including Charge Description Master (CDM) or ability to quickly learn these concepts.
• Strong analytical clinical and interpretive skills to support revenue capture CDM analysis and compliance with federal state and local healthcare regulations.
• Proficiency in project management principles to lead initiatives independently.
• Ability to work autonomously take initiative and solve problems with minimal supervision.
• Detail-oriented with strong analytical written and oral communication skills.
• Flexibility to adapt to frequently changing regulations.

• Minimum of 5 years of recent experience (within the last 2 years) in hospital denial management with expertise in denial resolution processes and reimbursement methodologies.
• Experience interpreting managed care hospital contracts.
• Record of effective collaboration to meet hospital or system performance targets.
• Verifiable success in improving cash collections and achieving targets for net days in accounts receivable.
• Experience maintaining strict confidentiality in a high-volume environment.
• Recent experience (within 2 years of hire) using Microsoft Office Word and Excel in a Windows environment.
• Experience with online coding applications.
• Advanced proficiency in Microsoft Office Suite (Word Excel) and database programs for managing complex data.
• Knowledge of diverse reimbursement methodologies.
• Familiarity with medical terminology and computer applications.
• Proven ability to make and implement challenging decisions effectively.
• Familiarity with Epic applications.
• Demonstrated leadership in a team-based healthcare revenue cycle environment.

The position is expected to work standard Monday - Friday business hours.