Vail Health

Manager

• Supervises, trains, and develops Revenue Integrity team members to ensure effective performance and adherence to best practices in revenue cycle operations.
• Oversees the management and maintenance of the Charge Description Master (CDM) to ensure accuracy, compliant effective and efficient operations. Work to implement strategies to improve charge capture and prevent revenue leakage.
• Develops CDM-related departmental, division and/or organizational policies and procedures for recommendation and approval including but not limited to pricing, CDM audits, charge reconciliation, and charge capture. Create and execute work plans to successfully implement changes to systems and/or process as necessary.
• Leads efforts of multidisciplinary groups where necessary to monitor the completeness and accuracy of revenue and billing information.
• Leads organization RAC Denials team and works closely with the Patient Financial Services ("PFS") to track and monitor coding-related denials.
• Coordinates and/or participates in system testing as a result of upgrades, changes, enhancements, new application implementations, etc. that may impact the CDM, charge capture and/or charge data flow between systems or modules.
• Analyzes financial and clinical data to identify trends, revenue improvement opportunities, and potential risks. Monitor key performance indicators (KPIs) and provide regular reports on revenue integrity performance.
• Partners with finance, billing, compliance, and revenue cycle to develop strategies and ensure alignment across departments.
• Actively promotes and participates in initiatives to improve organization effectiveness and efficiency.
• Works with departmental managers to ensure that clinical charges and billing codes are fully and correctly established in Electronic Medical Record patient care applications and are captured by Electronic Medical Record patient billing applications. Provides education as needed to departments related to their charges and charging practices.
• Regularly attends and actively participates in staff meetings, in-services and continuing education programs as offered in order to remain current with organizational and industry changes. Communicate and disseminate information to other departments as applicable.
• Successfully maintains staff engagement and satisfaction scores for responsible departments based on periodic internal surveys at or above the stated organizational goal.
• Role models the principles of a Just Culture and Organizational Values.
• Must be HIPAA compliant

Manager, Revenue Integrity

Accounts Receivable

• Under the direction of leadership responsible for accounts receivable, cash posting and credit balance review functions.
• Cash posting duties include the application of daily payments to patients’ accounts, ensuring payments, allowances, adjustments, and denials are posted accurately and in a timely manner.
• Prepares deposits, records general ledger (GL) entries, performs batch reconciliations and investigates discrepancies.
• Credit balance review duties include reviewing, researching, and analyzing accounts receivable credit balances.
• Demonstrates high working knowledge of managed care contracts and major third party payers.
• Assist Accounting Manager with monthly closing processes including generating various billing system reports and reconciliation of accounts.
• Assists with tracking denials and identifying causality relations between delays in payment and denials and variables such as procedure codes, insurers, or physicians and communicates findings to billing/collections office.
• Assists with the annual external audit by preparing schedules and gathering requests as needed.
• Assembles data and composes special reports as requested by the Accounting Manager or Director of Business Operations.
• On an as needed basis will assist and back-up other front office staff positions.
• Actively participates as a collaborative member of the department team by communicating constructively, identifying business office and interdepartmental problems, and resolving conflicts appropriately.
• Demonstrates professional conduct and appearance and is accountable for actions and outcomes.
• Demonstrates ability to give and receive peer review and feedback and incorporates this into his or her work.
• Role models the principles of a Just Culture and Organizational Values.
• Perform other duties as assigned. Must be HIPAA compliant.

Accounts Receivable Specialist

Billing Specialist

• Responsible for collection activities including but not limited to insurance follow-up, resolving denials & rejections, submitting re-bills, re-submit claims, and file appeals.
• Acts as the back-up for the billing function, posts charges and submits insurance claims.
• Completes required reports and assists with special projects as assigned.
• Backs up other front office positions as needed.
• Performs claims follow-up by working aging and denials.
• Applies knowledge of insurance contracts and medical procedure reimbursement.
• Coordinates resubmission of claims when necessary.
• Submits appeals with supporting documentation when warranted.
• Identifies denial trends and works with management and payers to resolve issues.
• Contributes to team effort to meet collection goals and reduce A/R days.
• Investigates insurance overpayments and submits refund requests to department manager.
• Exhibits strong problem-solving and research skills to ensure solutions are found.
• Role models the principles of a Just Culture and Organizational Values.

Security Engineer

• Configures, maintains, and optimizes Epic Contract Management to reflect payer contracts, rates, and reimbursement rules.
• Translates contract language into Epic system build for appropriate modeling of terms, conditions, and reimbursement methodologies.
• Conducts contract load validation, modeling, and testing to ensure accuracy of expected reimbursement calculations.
• Collaborates with Managed Care teams to review new and updated payer contracts, ensuring accurate system representation.
• Partners with Revenue Integrity and Finance to monitor underpayments, variances, and trends, providing insights for recovery and process improvement.
• Develops, maintains, and distributes reports and dashboards to support contract performance monitoring.
• Provides end-user support, training, and documentation related to Epic Contract Management functions.
• Acts as liaison between IT and operational stakeholders, ensuring system solutions meet business needs.
• Maintains knowledge of industry best practices, CMS regulations, and payer reimbursement methodologies.
• Leverages Epic analytics platforms to assist with driving operational outcomes for the health system.
• Performs other duties as assigned. Must be HIPAA compliant.

IT Security Architect

Administrative Assistant

• Maintain up-to-date and compliant credentialing files for providers, including licensure, DEA, insurance, and certification tracking
• Monitor expirables and manage timely renewal and documentation of credentials
• Prepare and submit provider enrollment and re-credentialing applications for Medicare, Medicaid, and commercial payers
• Manage CMS provider revalidations and update provider information across portals including CAQH, PECOS, Availity, and NPPES
• Coordinate hospital credentialing and reappointment processes and serve as liaison with medical staff offices
• Maintain provider rosters, enrollment spreadsheets, and credentialing trackers; securely manage provider passwords and sensitive documentation
• Collaborate with billing teams to resolve enrollment-related claim issues and respond to payer documentation requests
• Provide administrative support to the Supervisor of Provider Services and Provider Operations Department
• Support ad hoc operational and project-related tasks and role model Just Culture and Organizational Values

Manager, Revenue Integrity

Accounts Receivable Specialist

Billing Specialist

IT Security Architect

Credentialing and Administrative Support Specialist