Manager, Appeals & Underpayments at Aspirion

Alameda, California, United States -

Full Time

Start Date

Immediate

Expiry Date

13 May, 26

Salary

68000.0

Posted On

12 Feb, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Revenue Cycle Management, Underpayment Analysis, Contract Interpretation, Data Analysis, Team Management, Healthcare Compliance, Presentation Skills, Negotiation, Problem Solving, SQL, Data Manipulation, Charge Capture, Leadership, Communication, Analytical Skills, Client Engagement

Industry

Hospitals and Health Care

Description

Description For over two decades, Aspirion has delivered market-leading revenue cycle services. We specialize in collecting challenging payments from third-party payers, focusing on complex denials, aged accounts receivables, motor vehicle accident, workers’ compensation, Veterans Affairs, and out-of-state Medicaid. At the core of our success is our highly valued team of over 1,400 teammates as reflected in one of our core guiding principles, “Our teammates are the foundation of our success.” United by a shared commitment to client excellence, we focus on achieving outstanding outcomes for our clients, aiming to consistently provide the highest revenue yield in the shortest possible time. We are committed to creating a results-oriented work environment that is both challenging and rewarding, fostering flexibility, and encouraging personal and professional growth. Joining Aspirion means becoming a part of an industry leading team, where you will have the opportunity to engage with innovative technology, collaborate with a diverse and talented team, and contribute to the success of our hospital and health system partners. Aspirion maintains a strong partnership with Linden Capital Partners, serving as our trusted private equity sponsor. We're seeking an experienced revenue cycle expert to manage multiple ongoing client engagements, manage staff, prepare and present detailed reports, analyze revenue opportunities, interpret contract terms, and anticipate legislative changes affecting reimbursement. In addition, we would ask you to provide our clients with claims data showing payer performance and root-cause analysis of underpayment issues, which can be leveraged when negotiating with payers and assessing the overall business performance. Ideal candidates will have extensive underpayment knowledge, prior supervisory experience, and advanced presentation skills. Key Responsibilities Analysis of hospital contracts to identify potential underpayment opportunities Translation of contract terms into mathematical formulas to identify underpaid claims Identify opportunities for process improvements for both client and internal processes Manage day-to-day work of 15-20 direct reports Train staff in the areas of underpayment identification, healthcare industry processes and standards, communicating and negotiating with insurance companies Escalate and resolve payment disputes with payer and serve as a liaison between client and payer Establish metrics to monitor staff performance; prepare and deliver performance evaluations and resolve any staff related issues Provide Subject Matter Expertise support with clients and staff Requirements Thorough understanding of reimbursement methodologies (Health Insurance contracts, Medicare, and Medicaid) Excellent written and verbal communication skills Knowledge of government compliance rules and issues as it pertains to healthcare billing and reimbursement Comfort with large data sets, manipulating data in SQL, MS Access and comparable database platforms Proven leader, experience managing teams; ability to motivate and mentor junior staff Self-directed and organized with analytical and problem-solving skills Comfortable presenting to both internal and externa stakeholders, including C-suite level members Ability to develop logic to price claims under various reimbursement methodologies including coordination of benefits, third party liability, Diagnosis Related Groups (DRGs), Case Rates, Ambulatory Payment Classification (APC), Outpatient Fee Schedules, Division of Financial Responsibility (DoFR) and Capitation Knowledge of the charge capture processes; prior experience conducting charge capture audits is a plus Balance and maintain day-to-day operational duties while also performing providing leadership responsibilities Company wide engagement and leadership Education and Experience Bachelor’s degree in healthcare management, Business, Finance or Accounting or an equivalent combination of education and experience Minimum 5 years healthcare experience; patient account services, revenue cycle operations or payer contracting Experience with Zero Balance claims preferred Prior supervisory experience preferred Benefits At Aspirion we invest in our employees by offering a full benefits package, including health, dental, vision and life insurance upon hire, matching 401k, competitive salaries, advancement opportunities, and incentive programs. The US base pay range for this position starts at $68,000 annually. Individual pay is determined by a number of factors including, but not limited to, job-related skills, experience, education, training, licensure or certifications obtained. Market, location and organizational factors are also considered. In addition to base salary, a competitive benefits package is offered. AAP/EEO Statement Equal Opportunity Employer/Drug-Free Workplace: Aspirion is an Equal Employment Opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, pregnancy, religion, national origin, ancestry, medical condition, marital status, gender identity citizenship status, veteran status, disability, or veteran status. Aspirion has a Drug-Free Workplace Policy in effect that is strictly adhered to. Please note that this position is contingent upon the successful completion of a pre-employment drug screening and background check. These steps are part of our standard hiring process to ensure a safe and compliant workplace.

Responsibilities

The Manager, Appeals & Underpayments will manage multiple client engagements, oversee staff, and analyze revenue opportunities. They will also provide clients with claims data and root-cause analysis of underpayment issues.