Become a part of our caring community and help us put health firstThe Revenue Cycle Manager (Onshore Operations) oversees the onshore team responsible for the comprehensive management of revenue cycle processes, including credit balance validation, customer service escalations, payment reconciliation, and auditing. This role includes overseeing the Payment Reconciliation Professional and Payment Posting Auditors who work to ensure accurate financial operations and proper payment posting. The manager is also responsible for process improvements and ensuring compliance with organizational and regulatory standards.
Key Responsibilities:Team Management & Oversight:- Lead and manage the onshore team responsible for credit balance validation, customer service escalations, and adjustments.
- Oversee the Payment Reconciliation Professional who reconciles payment posting with the bank and manages all EDI/ERA/EFT setup and troubleshooting.
- Supervise the Payment Posting Auditors who audit offshore payment posting work to ensure accuracy and compliance with internal controls.
Payment Reconciliation & Posting:- Ensure that payment posting reconciliations between the general ledger, payment posting systems, and bank accounts are completed accurately and in a timely manner.
- Oversee the setup and management of EDI, ERA, and EFT configurations to ensure smooth payment posting operations.
- Coordinate with finance to resolve any discrepancies in payment reconciliation.
Auditing & Quality Control:- Oversee the auditing of the offshore payment posting team's work, ensuring accuracy in all payment postings.
- Conduct reviews of refunds, adjustments, credit balances, and variances to ensure compliance with financial policies.
- Supervise "auditing the auditor" activities to ensure the integrity of internal and external audit processes.
Credit Balance & Refund Processing:- Supervise the accurate processing of credit balances, including insurance and patient refunds, ensuring timely and compliant resolution.
- Manage the team responsible for patient and insurance refunds and ensure alignment with regulatory standards.
Customer Service Escalations:- Ensure that customer service escalations related to billing or AR issues are addressed and resolved within established timelines.
Variance Review & Adjustments:- Manage the team's efforts in reviewing variances and making necessary contractual or administrative adjustments.
- Oversee the proper handling of inactive or deceased patients' accounts and claims without insurance.
Process Improvement & Reporting:- Identify and implement improvements in the payment reconciliation and posting process.
- Provide regular reporting on the team's KPIs and ensure alignment with organizational goals.
Required Qualifications- Bachelor's Degree
- 6 or more years of revenue cycle experience
- 2 or more years of management experience
- Experience completing revenue cycle reporting and analysis
Preferred Qualifications- Certified Revenue Cycle Representative Certificate
- Experience leading a team of revenue cycle professionals
Use your skills to make an impact AlertHumana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from H[redacted] with instructions on how to add the information into your official application on Humana's secure website.
Interview Format - HireVueAs part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Work-At-Home RequirementsTo ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
BenefitsHumana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:
- Health benefits effective day 1
- Paid time off, holidays, volunteer time and jury duty pay
- Recognition pay
- 401(k) retirement savings plan with employer match
- Tuition assistance
- Scholarships for eligible dependents
- Parental and caregiver leave
- Employee charity matching program
- Network Resource Groups (NRGs)
- Career development opportunities
Scheduled Weekly Hours40
Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$76,800 - $105,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About usAbout Conviva: Conviva Care Centers provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of Humana's Primary Care Organization, which includes CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.
About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity EmployerIt is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
