Role Description Analyzes and interprets data to initiate and facilitate implementation of solutions for process, quality and procedural improvements within the Enterprise Revenue Cycle, Mayo Clinic, and Mayo Clinic Laboratories by understanding Revenue Cycle operations, processes, systems, regulations, clinical practice, payer changes and data. - Analyzes, designs, and redesigns processes, workflow, and systems to ensure quality, effectiveness and efficiency. - Identifies resource impact and manages the implementation cycle. - Leads and facilitates process improvements by understanding system dependencies. - Participates in the design, development, testing, implementation, training and maintenance of new business process and system applications with Systems Services staff; coordinating operational input and resources. - Leads effective meetings, workgroups, and committees which include participants throughout Mayo Clinic to facilitate and negotiate issues with institutional impact. - Specifies and acquires resources for project completion. - May serve as primary resource for Enterprise Revenue Cycle. - Possesses ability to make appropriate decisions regarding complex operational issues having an Enterprise Revenue Cycle or Mayo Clinic impact. - Interacts collaboratively with various departments to support and direct activities and work flows. - Collaborates with leadership to resolve Enterprise Revenue Cycle issues. - Partners with appropriate areas to ensure compliance with federal and state requirements. - Works with external vendors and/or internal stakeholders as a subject matter expert to analyze issues and resolutions. - Mentors and develops staff. - Maintains knowledge of current healthcare environment. - May need to present before local, state and national conferences and user group meetings. - Ensures changed processes are incorporated into training and internal control materials for Enterprise Revenue Cycle staff and other users. - Provides regular updates to senior leadership. - Solicits and makes key decisions. - May provide direct supervision to staff. - Understands and is accountable for ensuring a control environment is maintained to preserve Mayo's Standard of Ethics and minimize the financial and legal risks for Mayo. - May work evening and weekend hours and travel as needed. Benefits - Medical: Multiple plan options. - Dental: Delta Dental or reimbursement account for flexible coverage. - Vision: Affordable plan with national network. - Pre-Tax Savings: HSA and FSAs for eligible expenses. - Retirement: Competitive retirement package to secure your future. Company Description Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation and comprehensive benefit plans to take care of you and your family, now and in the future. And with continuing education and advancement opportunities at every turn, you can build a long, successful career with Mayo Clinic. - Our employees are located at our three major campuses in Phoenix/Scottsdale, Arizona, Jacksonville, Florida, Rochester, Minnesota, and at Mayo Clinic Health System campuses throughout Midwestern communities, and at our international locations. - Each Mayo Clinic location is a special place where our employees thrive in both their work and personal lives.

• Support proper implementation of EVMS and project management tools and processes through coordination with and guidance. • Provide project management guidance to program team. • Perform risk assessments and what-if analysis. • Actively support monthly program Estimate-at-Complete reviews. • Facilitate monthly data reconciliation and compile compliant Earned Value or project plan data. • Support on-going compliance reviews and periodic process audits. • Ensure the team meets aggressive demands of military compliance programs.

• manage Pharmacy Benefit Management processes • ensure timely and accurate eligibility data processing • collaborate with cross-functional teams to improve service delivery

• Prepare, update, and submit stop loss filing packages, including initial, subsequent, and year-end filings as needed • Track claim activity and follow up through to completion with stop loss carriers and other stakeholders to help ensure reimbursements are received accurately and timely • Monitor assigned employer groups and clients using reports, analysis, and reimbursement activity trends • Assist in researching and reconciling discrepancies between requested reimbursement amounts and amounts returned by stop loss carriers • Serve as an advocate for clients by helping capture the maximum eligible reimbursements available under applicable stop loss policies • Review claim documentation for completeness, accuracy, and alignment with policy provisions and filing requirements • Research and resolve cases that require additional analysis, documentation, or explanation • Communicate with internal and external stakeholders to obtain information, resolve issues, and support timely filing resolution • Partner with cross-functional teams, including areas such as underwriting, finance, eligibility, and client support, to facilitate filing resolution • Maintain accurate records, logs, and supporting documentation related to assigned stop loss filings and reimbursements • Escalate complex issues or delays appropriately and support process improvement efforts when trends or gaps are identified