PFS Manager of Payment Integrity

The PFS Manager – Payment Integrity leads the Payment Integrity team, overseeing billing, clearinghouse, payment posting, and payment variance functions within the Patient Financial Services department. This role drives strategic initiatives aligned with Epic system workflows and industry best practices, including Healthcare Financial Management Association (HFMA) and Medical Group Management Association (MGMA) standards. The Manager is responsible for optimizing team performance and operational workflows to ensure staff are fully utilized and patient financial services processes are efficient, accurate, and compliant. This leadership position collaborates across departments to foster an engaging work environment and enhance overall patient, family, and staff experience. The Manager collaborates with internal teams and payors to optimize revenue cycle performance and support organizational financial goals.

The PFS Manager of Payment Integrity performs several duties to ensure the proper functioning of the Payment Integrity team.
• Leads strategy and performance tracking for the daily operations of billing, clearinghouse, payment posting, and payment variance teams
• Oversees Epic system optimization strategy for Hospital Billing (HB) and Professional Billing (PB) Resolute workflows
• Ensure timely and accurate posting of payments and reconciliation of remittances.
• Manage clearinghouse workflows, and root cause analysis to reduce future edits or rejections
• Ensure compliance with Price Transparency, No Surprises Acts and other payor-specific requirements
• Develops policies, procedures, and training programs to support onboarding and continuous process improvement
• Collaborates with Revenue Cycle teams and other operational stakeholders to ensure seamless patient flow and account management
• Monitors KPIs including but not limited to, system-wide cash posting and cost-to-collect performance attributed to Patient Financial Services as well as accounts receivable balance 
greater than 180 days, electronic transmission of claims and receipt of remittances, and patient satisfaction 
• Supervise billing processes and clearinghouse transmissions to ensure clean claim submission
• Collaborate with IT and Epic teams to resolve billing and posting system issues
• Examine current processes to identify process improvement opportunities
• Train and mentor staff, conduct performance evaluations, and support professional development
• Ensure compliance with regulatory requirements and internal policies
 

Required Minimum Education:
• Bachelor’s degree in Healthcare Administration, Business, or related field.
• In lieu of degree, a minimum of 5 years of progressive experience in revenue cycle operations or payor performance measurement may be considered.
 

Required Minimum Certification:
• No certifications required; HFMA CRCR or CPAR preferred
• Epic HB and or PB Resolute certification preferred
 

Required Minimum Skills:
• Strong leadership and organizational skills with the ability to manage human resources and patient financial services operations.
• Strong working knowledge of healthcare access workflows, payer requirements (Medicare, Medicaid, Managed Care, Workers’ Compensation, and charity funding), and Revenue Cycle terminology.
• Proficiency in healthcare systems (Epic preferred), Microsoft 365; familiarity with data warehouse, reporting and analytics a plus.
• Working knowledge of CPT, HCPCS, and ICD-10 coding standards to support admission compliance.
 

Physical Demands:
• Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time or exerting up to 15 pounds of force occasionally or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body
 

Working Conditions:
• This is an onsite role based at Shepherd Center; occasional flexibility may be granted to attend to personal matters, with prior approval and in alignment with departmental needs
• No potential for exposure to blood and body fluids.