Business Operations and Reimbursement Manager

Responsible for maintaining TUMG Master Fee Schedule, tracks payer fee schedule updates and coordinates with vendors to ensure timely and accurate uploads and performing in-depth payer reimbursement and variance analysis, supporting payer negotiations, and advising on strategic pricing decisions. This role ensures contract compliance, coordinates with A/R team to resolve over/underpayments, and supports efforts to optimize revenue cycle operations and reimbursement accuracy through collaboration with internal teams, payor relations, and third-party vendors.

            REQUIRED EDUCATION AND EXPERIENCE:

• Bachelor’s Degree with two (2) years’ experience in revenue cycle management, medical coding, payer payment variances.
  

  
  PREFERRED QUALIFICATIONS:  

• Master’s Degree: minimum four (4) years’ experience in healthcare setting preferred.

• Demonstrated proficiency in the utilization of Data Visualization tools such as Power BI, Excel and other software for analyzing data.

• Experience with hospital or clinical charge description master (CDM) and payer fee schedules; knowledge of  global fees, professional fees, and technical fees; experience in medical billing, collections, and coding practices and procedures.

• Deep understanding of managed care, government contracts, and reimbursement processes.

• Strong data analysis skills with the ability to compile and interpret complex data sets related to contract compliance and payment trends. 

• Experience in Fee Schedule Analysis and Management

• RVU Validation and Yearly Review and Update

• Excellent communication and interpersonal skills for working with internal teams and external payer representatives.

• Knowledge of medical coding systems (ICD, CPT, HCPCS, etc.) and payer fee schedules.

• Oversight of Financial and Business Office staff and functions related to Revenue Cycle

• Ability to maintain confidentiality in all work performed.

• Excellent organizational and time management skills; ability to effectively manage multiple tasks simultaneously and meet established deadlines.

• Excellent skills using MS Word, Excel and PowerPoint