Program Manager, Revenue Cycle

Get To Know Summit Pacific Medical Center

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
  
  

To learn more about Summit Pacific, visit www.summitpacificmedicalcenter.org

Pay Range (depending On Experience)

$37.79 - $57.61

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 payment processing functions.
• Ability to work collaboratively and effectively with multiple demands and sort time frames.
• Ability to work independently performing a wide variety of assignments that require the use of independent judgment, problem-solving, organization, and prioritization skills.
  
  

Work Shift

Exempt Staff

Working Location:

Elma, Washington

Benefits

Our uniquely designed benefits are here to support you and your family in staying well, growing professionally and achieving financial security!

We take care of you, so you can focus on delivering our mission of caring for everyone, especially the most vulnerable in our communities.

Benefits Offered By SPMC

• Competitive Compensation
• Medical
• Prescription
• Dental (including Orthodontia)
• Vision
• Healthcare FSA and daycare FSA
• Daycare subsidized benefit
• Life Insurance
• Accidental Death and Dismemberment (AD&D)
• Short- and long-term disability
• Generous employer 403b match contributions for retirement
• 457 retirement account for additional funds
• Employee Assistance Program (EAP)
• Tuition reimbursement
• Smoking Cessation Assistance
• Employee Wellness Program
• Employee Committees to participate in such as Spirit Team
• Beautiful on-site gym for employees
• Instructor led fitness classes for employees, including Yoga, Kettlebells and Bootcamps
• Walking trails on site
  
  

Additional Information

• Summit Pacific is a vibrant and expanding nonprofit public hospital district serving east Grays Harbor County, Washington. Founded in 1982, Summit Pacific now operates three locations comprised of a critical access hospital, primary care clinics, an urgent care clinic and range of ancillary and specialty services.
• Far enough to have privacy and enjoy the small-town lifestyle, yet close enough to have the benefits of the city. There are many year-round recreational activities in and around Grays Harbor such as:
• Hiking/ walking trails – whether you’re looking for short easy walking trails or long hikes you can find many trails located either on site or just miles from Summit Pacific. There are many great hiking trails about an hour away at the Quinault Rainforest which is also the home of some of the largest trees in the world!
• Kayaking – There are many areas that are easily accessible and have beautiful views.
• Nature viewing – Multiple whale watching towers and tours, state parks, Olympic Game Farm (where you can feed the animals straight from your car)
• Fishing & Hunting – If you’re looking for areas to hunt/ fish or looking for guided tours this is a great area! Westport is just 42 miles away with many opportunities to catch or buy fresh fish off the docks!
• Other activities – Multiple museums, winery, arcades, rentable mopeds, Seabrook (vacation beach town), many areas to surf for experienced surfers and surfing lessons for those who want to learn.
• Nearby colleges – Grays Harbor College is a community college located in Aberdeen with other community colleges located in surrounding areas, as well as some state colleges and universities in other areas of WA state.
  
  

Summit Pacific Medical Center is an equal opportunity provider and employer that is committed to a policy of non-discrimination on the basis of race, sex, age, religion, color, national origin, ancestry, disability, marital status, arrest and court record, sexual orientation, and status as a covered veteran. This policy covers admission and access to, and participation in, treatment and employment in the hospital’s programs, activities, services, and employment.

This organization participates in E-Verify. E-Verify is a service that verifies authorization to work in the U.S. through the U.S. Department of Homeland Security (DHS) and the U.S. Department of Social Security (SSA). For further information on E-Verify contact DHS at 1-888-464-4218.