Program Manager, Revenue Cycle

Your trusted partner in Health and Wellness, Summit Pacific is a vibrant and expanding public hospital district that operates a Critical Access Hospital with a Level IV trauma designation, three rural healthcare clinics, and a seven-day-a-week urgent care clinic. Our vision is "Through Summit Care, we will build the healthiest community in the Nation." Our hospital is unique due to its size and accessibility. We pride ourselves on our ability to give patients quick access to a provider.

• Critical Access Hospital
• 24/7 Emergency Department
• Level II Cardiac Center
• Level III Stroke Center
• Level IV Trauma Care

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Job Summary

The Revenue Cycle Program Manager is responsible for development and oversight of Revenue Integrity within the Revenue Cycle Department. This role includes direct accountability for the Charge Description Master (CDM), Billing, and Reimbursement analysis, with a strong focus on financial performance and regulatory compliance. Serving as the Chargemaster and Denials Prevention Analyst, the Program Manager partners with internal and external stakeholders to optimize revenue capture and ensure accurate claims administration. They monitor charge reports to identify and resolve issues related to system failures, workflow inefficiencies, or configuration changes. By reviewing denial trends, the Program Manager identifies opportunities for improvement and acts as a liaison between Revenue Cycle and departmental leaders. Through the development of data-driven strategies, reporting tools, dashboards, and KPIs, this role delivers actionable insights that enhance operational performance and support informed decision-making across Summit.

Job Specific Duties and Responsibilities

• Responsible for the oversight of Charge Description Master (CDM) functions and reimbursement analysis.
• Develop reports for determining and identifying opportunities with claim Denial data across all revenue generating departments.
• Supervises and coordinates Chargemaster and Charge Capture processes, including researching coding and billing guidelines, insurance contracts, and updating hospital and professional CDM and charge capture workflows.
• Collaborates with revenue-producing departments to ensure coordinated and consistent CDM and charge capture processes, including accurate descriptions, coding, additions, deletions, pricing, revenue codes, and other necessary updates.
• Validates denial reasons and ensures coding in the CDM is accurate and reflects the denial reasons; coordinates with other departments when necessary.
• Maintains working knowledge of revenue cycle processes to support implementation of regulatory standards that enhance cash collection and ensure billing compliance.
• Performs analysis to identify trends and validate compliance related to fiscal activities, with a focus on generating additional revenue, reducing bad debt and charity write-offs, and minimizing overall expenses.
• Disseminates CMS updates to healthcare providers regarding billing for drugs, implantable, and other pass-through eligible items, ensuring timely and compliant updates to entity-specific CDM and charge capture systems.
• Develops policies and procedures impacting charge capture and pricing practices.
• Serves as a resource and consultant to various internal departments and stakeholders.
• Reviews and monitors key performance indicators to identify improvement opportunities and ensure adherence to regulatory and non-regulatory directives.
• Oversees pricing initiatives including strategic pricing, tiered pricing, transparency efforts, and interim pricing reviews; conducts financial analyses for strategic initiatives.
• Performs other duties and special projects as assigned.

*Essential Job Function

Staff Member Responsibilities

• *Adapts to changes in the work environment:  Asks clarifying questions and/or provides constructive input in a helpful and respectful manner.
• *Builds and maintains working relationships: Maintains effective working relationships with supervisor and direct co-workers.
• *Creates positive experiences for patients, customers and, co-workers: Consistently provides a level of service that meets SPMC standards.
• *Demonstrates ongoing learning & development: Participates in ongoing skills training and competency development.
• *Exhibits effective work skills: Successfully performs job duties in accordance with SPMC expectations for quality/accuracy, quantity, and timeliness. Re-priorities and/or shifts focus as needed to deliver expected results.
• *Facilitates Teamwork: Actively engages in team activities. Welcomes and supports new team members; promotes a positive work environment. 
• *Fosters an environment of trust: Treats others with courtesy and respect. Does not engage in gossip or triangulation. 
• *Supports SPMC mission, vision, and values: Develops awareness of departmental contribution to mission, vision and strategy. Participates in department strategies and tactics.

Organizational Responsibilities

In addition to the duties and responsibilities listed above, all employees are expected to adhere to Summit Pacific behavior and patient experience standards, comply with policies, procedures, and regulatory guidelines; and act in an ethical, professional, respectful, and collaborative manner.

Required Education and Experience

• Graduate of an accredited school with a minimum of an associate degree. Bachelor's degree in Math, Statistics, Biostatistics, Public Health, Finance, Accounting or closely related field is preferred.
• Three (3) years of healthcare revenue cycle, data analysis and reporting experience preferred.

Required Licenses, Certifications and/or Registrations

Washington Health Benefit Exchange In-Person Assister Certification is required at the time of hire and/or within 90 days of accepting the position.  

Required Knowledge, Skills, Abilities

• Comprehensive knowledge of the patient access/registration, coding, chargemaster, charging and billing work environments, workflows, and tasks.
• Knowledge of medical terminology.
• Intermediate to advanced skills in statistical modeling, data mining, analysis, and reporting.
• Knowledge of financial and benchmarking standards and related best practices.
• Proficient in the use of current technology, including Microsoft Office products.  Ability to learn and effectively use electronic medical records and other systems and equipment.
• Ability to develop and maintain proficiency with insurance verification processes via multiple online and telephone insurance registry systems.
• Strong problem-solving and organization skills; ability to effectively prioritize work.
• Professional and effective written and verbal communication skills. Ability to identify and employ communication strategies appropriate to the audience.
• Strong mathematics skills and knowledge of