Empower Every New Yorker - Without Exception - to Live the Healthiest Life Possible

NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city's five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible.

At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.

Job Description

SUMMARY OF ESSENTIAL DUTIES AND RESPONSIBILITIES:
The Central Office Managed Care team is seeking to hire an Assistant Director of Fiscal Affairs with experience in healthcare reimbursement to enhance high cost outlier revenue opportunities by collaborating with hospitals to ensure appeals are properly pursued with contracted payors. This revenue-generating role involves knowledge of hospital high cost outliers, healthcare claims, contract language, payment methodologies and state and federal guidelines. This person will report directly to the Managed Care team.
• Support Director of Fiscal Affairs to monitor high cost outlier revenue by developing payor-specific standard appeals processes and guidelines for management of appeals status and documentation in Epic Hospital Billing accounts, with a key focus on compiling relevant data from payor portals.
• Review and analyze accounts that qualify for high cost outliers and create a centralized database to track timely generation of appeals and reimbursement.
• Develop reports and metrics for senior leadership and other Central Office departments to track revenue and advocate for areas of improvement using EPIC and other reporting tools.
• Independently liaise with contracted payors or their designated vendors through routine email communications and recurring and ad-hoc meetings to resolve unpaid outlier cases and triage issues related to underpayments and denials. Communicate findings with internal stakeholders.
• Collaborate with internal operational areas, Central Office departments and some external vendors, to identify denial and underpayment trends to present to senior leadership and MCO.
• Identify and advocate for areas in need of process improvement to reduce denial rates and payment variances such as EPIC contract maintenance, adherence to contract terms, billing modifications and operational workflows.
• Monitor Epic work queues on a routine basis to support hospitals and ancillary facilities in grievance and appeals cases and collaborate with hospitals and Central Office departments to resolve aging accounts.
• Assist in special revenue projects, as needed, to gather and analyze data, perform research and create reports and databases.
• Other duties as assigned.

Minimum Qualifications
1. Master's degree from an accredited college or university in Accounting, Finance, Business Administration or a related discipline with an emphasis on accounting and financial systems; and two (2) years of responsible-level experience in fiscal management or administration with an emphasis on financial systems, management information and controls, one (1) year of which must have been in a responsible administrative or managerial capacity; or
2. Bachelor's degree from an accredited college or university in disciplines, as listed in "1" above; and three (3) years of experience, as described in "1" above, one (1) year of which must have been in a responsible administrative or managerial capacity.

Department Preferences

• Five (5) plus years of experience working with healthcare data and health insurance claim reimbursement.
• Strong understanding of Managed Care and Government reimbursement methodologies.
• Strong understanding of DRG hospital billing.
• General knowledge of hospital operations (Revenue Cycle: Registration, Patient Accounting/Billing, data processing).
• Data analytics and experience with EPIC.

If applying online, please include your cover letter in the same file attachment with your uploaded resume.

NYC Health and Hospitals offers a competitive benefits package that includes:

• Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
• Retirement Savings and Pension Plans
• Loan Forgiveness Programs for eligible employees
• Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
• College tuition discounts and professional development opportunities
• Multiple employee discounts programs