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Senior Manager, Student Health Insurance Program & Revenue Operations - Student Health Engemann Admin - Full Time 8 Hour Days (Exempt) (Non-Union)Apply Keck Medicine of USC Hospital Los Angeles, California

The Senior Manager, Student Health Insurance Program & Revenue Operations is responsible for the efficient management of the Health System's Student Health Insurance Program, patient billing procedures and processes, and the supervision and collection of revenue from both internal and external sources. The Senior Manager works closely with Student Health executive leadership to plan, deploy and analyze functions and strategies that maximize the fiscal support of Student Health Services while ensuring that health care insurance and services are competitively and reasonably priced for the student population.

The Clinical Documentation Improvement Program Manager uses clinical, coding and CDI expertise to perform daily operational management of the CDI program and CDI Staff. This position evaluates the adequacy and effectiveness of internal and operational controls designed to ensure that CDI processes and practices lead to appropriate execution of regulatory requirements and guidelines related to facility coding and CDI practices, including federal and state compliance standards. This position plays a key role in leading the initiative for reporting quality of care outcomes and in obtaining complete, accurate and compliant documentation for appropriate reimbursement of services provided and capture of clinical outcome measures. This position will work in concert with physician leadership, Health Information Management coders and leadership, as well as Quality and Compliance leadership to support timely, accurate and complete documentation of clinical information and the success of the CDI Program Department. Assists with the management of monthly, weekly and ad hoc reporting for CDI program performance, including that of CDI staff and providers. Assists in the performance of quality audits and analyzes the findings of performance audit information to build staff education, identify areas of individual and team performance opportunity and resolve as needed. Serve as a subject matter expert and authoritative resource on interpretation and application of CDI practices, coding rules and regulations and conducts risk assessments of potential and detected compliance deficiencies, as well as documentation improvement opportunities. This position will draft and manage CDI Program Department policies and processes. The CDI Manager will work with the Director of HIM and Coding Manager to implement CDI program strategy and collaboration with Quality, compliance to coordinate provider documentation best practice.

Essential Duties:

• Manages Student Health Insurance Plan Enrollment and Waivers: Plans and develops the Student Health Insurance Program objectives and content. Oversees the Student Health Insurance Plan waiver and enrollment processes for USC students and program participants. Researches and identifies trends and needs and recommends program directions accordingly. Assesses the quality of program operations and modifies existing program services to maintain or enhance program standing. Links the program with other relevant departments on or off campus, as necessary Ensures timely communication with eligible students regarding student health insurance plan options and enrollment requirements. Establishes partnerships with consultants, carriers, and campus partners to ensure viable and competitive insurance products. Ensures compliance with international health insurance requirements and study abroad programs including coordination of care with the university’s overseas services provider.

• Health Services Eligibility Management: Manages health center eligibility criteria for USC students and program participants, ensuring compliance and accuracy. Develops and implements streamlined procedures for eligibility assessments. Partners with internal and external departments to provide timely eligibility reporting.

• Patient Billing Management: Creates and edits health center fee schedules, transaction codes, and charge capture mapping within the EHR system. Reconciles health insurance premiums and student health fees. Collaborates with cross-functional teams to provide guidance and support. Identifies and implements opportunities to improve billing efficiency and accuracy. Reports patient cost changes to Executive Committee annually or as needed. Serves as the primary decision maker for billing inquiries, disputes and requests for special exceptions according to Student Health policy.

• Revenue Management: Performs budget forecasting, analysis, and financial reporting for insurance, health fee and fee for service revenue. Oversees invoicing and collections for external and interdepartmental billing. Identifies, prioritizes and resolves accounting issues relating to SHIP, SHF, patient billing and interdepartmental billing. Develops and monitors KPIs related to revenue and collections efficiencies and financial performance.

• Compliance, Communication, Resolution and Reporting: Manages PCI DSS Compliance to ensure security and privacy for health services collections per university policy. Acts as the primary point of contact for health center billing inquiries, SHIP inquiries, and overseas travel cases (24/7). Develops and delivers trainings, presentations, and communications for eligible students. Facilitates trainings and presentations to new providers during onboarding and to existing departments for changes and knowledge refreshers. Prepares and presents accurate reports regarding SHIP/SHF to executive leadership.

• Program Management: Coordinates programs and projects to meet departmental objectives. Hires, develops and terminates staff who support the program by providing advice and guidance to students and parents. Manages the departmental organizational structure based upon strategic priorities and performs annual performance reviews according to Keck policy. Networks and builds relationships with consultants, carriers and campus partners. Plans, organizes, schedules, tracks, and implements processes to meet departmental objectives Communicates complex problems and recommended actions to the leadership.

• Policy Development: Develops, implements, and streamlines policies and procedures related to SHIP, health center eligibility, patient billing and revenue management. Actively participates in departmental meetings, initiatives and committees as assigned.

• Performs other duties as assigned.

Required Qualifications:

• Bachelor’s Degree in Arts/Sciences (BA/BS) in Healthcare Administration, Business Administration, or related field

• 5 years Experience in health services management, preferably in a university or healthcare setting.

• Strong understanding of health insurance policies, enrollment processes, and compliance regulations.

• Excellent communication, leadership, and interpersonal skills.

• Proficiency in financial management, budgeting, and data analysis.

• Ability to prioritize, multitask, and work efficiently in a fast-paced environment.

Preferred Qualifications:

• Master’s degree in Arts/Sciences (MA/MS)

• Experience with Point and Click or similar EHR

Required Licenses/Certifications:

• Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire, and maintained by renewal before expiration date. (Required within LA City only)

The annual base salary range for this position is $110,240.00 - $181,896.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

REQ20149996 Posted Date: 06/17/2024