Business Operations and Reimbursement Manager
Tulane University Medical Group
- New Orleans, LA
Job description
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.
• 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
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.
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