Manager, RCM

Passionate about precision medicine and advancing the healthcare industry?

Recent advancements in underlying technology have finally made it possible for AI to impact clinical care in a meaningful way. Tempus' proprietary platform connects an entire ecosystem of real-world evidence to deliver real-time, actionable insights to physicians, providing critical information about the right treatments for the right patients, at the right time.

Position Overview:

Tempus is seeking a Revenue Cycle Manager with a strong focus on Post-Payment Appeals, Refunds, Audits, and Payer Relations to lead our dynamic team. This critical role encompasses the management of post-payment appeals, the development of refund policies, and the meticulous handling of payer audits. The ideal candidate will possess a background in revenue cycle management, complemented by paralegal expertise that is instrumental in navigating the complexities of audit documentation, research, and communication. A strategic mindset and robust leadership skills are essential for driving process optimization and ensuring compliance with payer requirements.

Key Responsibilities:Post-Payment Appeals & Refunds

• Manage the Tempus refunds and post-payment appeals team with a focus on continuous improvement and excellence.
• Develop and implement robust policies and procedures to ensure timely and accurate issuance of refunds where appropriate.
• Establish and monitor Key Performance Indicators (KPIs) to track and improve the efficiency and effectiveness of the post-payment appeals process.
• Create and maintain Standard Operating Procedures (SOPs) for the post-payment appeals team, ensuring compliance with all regulatory guidelines and payer requirements.
• Provide comprehensive feedback to management on trends, findings, and strategies for resolving issues with both in-network and out-of-network payers.
• Lead initiatives to identify root causes of overpayments and implement proactive measures to reduce the occurrence of future refunds.

Payer Audit Management

• Oversee the collection and organization of all necessary documentation in response to payer audits, ensuring meticulous documentation management.
• Conduct thorough research to support audit responses and appeals.
• Serve as the primary point of contact for all audit-related inquiries and correspondence, including writing clear, concise, and persuasive appeal response letters.
• Collaborate with external auditors and payer representatives, providing timely responses and addressing any queries or concerns effectively.
• Communicate effectively with clients and stakeholders regarding audit processes and outcomes.
• Work closely with relevant departments to address audit findings and implement corrective actions.

Requirements:

• Bachelor's degree in healthcare administration, business, or a related field (or equivalent experience).
• Familiarity with healthcare reimbursement, payer policies, and regulatory compliance in the revenue cycle.
• Strong paralegal skills, including documentation management, legal research, and client communication, are highly desirable.
• Excellent written communication skills, with the ability to produce clear, concise, and persuasive documents.
• Familiarity with healthcare reimbursement, payer policies, and regulatory compliance in the revenue cycle.
• Strong attention to detail and the ability to prioritize multiple competing tasks across projects, Third Party Billing Vendor, and internal Tempus teams.
• Proven track record of establishing and monitoring KPIs and SOPs within a revenue cycle context.
• Creative mindset in order to problem solve, comfort with ambiguity, and confidence to ask key questions.
• Ability to develop and maintain strong relationships across departments (Market Access, Finance, Legal, Product, Medical Affairs, Lab Ops, etc.).

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