Job Type: Regular

Time Type: Full time

Work Shift: Day (United States of America)

FLSA Status: Exempt

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

Job Description:

Reporting to HMFP's Director, Revenue Cycle Operations, the Manager of Professional Billing Revenue Cycle will be the revenue cycle subject matter expert for the Department of Surgery to handle professional charge reconciliation processes, work with billing vendor in addressing any billing and denials related issues that may be impacting department’s revenue cycle financial performance and proactively identify opportunities to improve the revenue cycle and assist in the resolution of issues.

Duties and Responsibilities:

Prepares and analyzes revenue cycle performance reports to monitor, track, and trend KPIs, performance, and physician productivity metrics; and performs root cause analyses of KPIs that fall below budget/target/or benchmark. Recommends and implements improvements based on analysis findings. Provides and presents metric reports and feedback to department leadership, division directors, providers, and other stakeholders on revenue cycle performance. Hold monthly meetings with department divisions to review revenue cycle performance and opportunities for improvement. Responsible for the Department of Surgery’s charge reconciliation process including generating and reviewing Epic Revenue Guardian charge reconciliation reports, charge interface reports, working with department staff to outreach providers and resolve all outstanding charges for rendered services. Responsible for identifying root cause, defining improvement opportunities related to initial professional denials and avoidable denial write-offs. Where appropriate, work with HMFP enterprise revenue cycle on broad-based initiativesCollaborates with the department’s Coding Compliance Manager to ensure billing and coding compliance, clinical documentation is complete, accurate, and timely; as well as ensuring all separately billable services are captured, coded, and billed timely and accurately for optimal revenue. Collaborates with the department’s Executive Director of Operations to implement process improvements for the department’s front-end processes related to registration, prior authorization, and referral related denials.Working closely with enterprise Manager, PB Revenue Cycle, assists with vendor management and oversight for the Department of Surgery’s third-party vendors to ensure revenue cycle optimization, quickly identifying areas of revenue leakage and gaps within revenue cycle functions, workflows, and processes; and implements corrective actions and improvements. Ensures billing vendor follows department and HMFP enterprise revenue cycle policies and procedures. Ensures that the Department of Surgery is following all HMFP Enterprise Revenue Cycle policies and procedures. Working collaboratively with department staff, responsible for defining and implementing the process on provider onboarding, credentialing, and enrollment functions within the Department of Surgery, working with department staff to ensure timeliness and completeness. Proactively identifies opportunities to improve all functions and processes within the revenue cycle to ensure efficiency, effectiveness, and optimal financial outcomes. Manages, facilitates, and participates in department specific revenue cycle projects; works collaboratively with cross-functional teams and other stakeholders to achieve department and organizational goals. Participates in HMFP Enterprise Revenue Cycle Improvement initiatives in addition to any department specific initiatives implementing strategies to reduce days in AR and reduce charge lag, collaborating with vendors and providers to address opportunities to improve.Works with HMFP Enterprise Revenue Cycle, as needed on payer relations (BILHPN) related to payer payment issues and contracting. Ensures timely and accurate payment based on contracted rates and addresses any underpayments. Serves as the department’s revenue cycle subject matter expert and liaison to all department providers and leadership. Works with HMFP Enterprise Revenue Cycle to resolve patient complaints and billing issues or questions.Assists with developing and implementing new processes and procedures, as necessary. Responsible for providing training and education specific to billing processes, rules, and regulations to department staff.

Reporting Relationship

Sr. Data Project Manager 

Required Qualifications:

High School diploma or GED required. Bachelor’s degree in finance, Business Management, Healthcare, or related field preferred.8-10 years related work experience required in medical billing, reimbursement, revenue cycle functions and/or other related areas and 3-5 years supervisory/management experience required.Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis, and maintain databases.

Preferred Qualifications:

Strong analytical ability. Proficient skills to collect, organize and analyze data, produce actionable reports, and recommend improvements and solutions.Proven ability and motivation to function as a change agent to streamline and improve processes. Strong interpersonal skills and work ethic are required.Experience with stakeholder management and cross-functional partnerships. Ability to collaborate with other team members and lead change in the execution of large-scale initiatives.

Competencies:

Decision Making: Ability to make decisions that are guided by precedents, policies, and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area.Problem Solving: Ability to address problems that are highly varied, complex, and often non-recurring, requiring staff input, innovative, creative, and Lean diagnostic techniques to resolve issues.Independence of Action: Ability to set goals and determines how to accomplish defined results with some guidelines. Manager/Director provides broad guidance and overall direction.Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families, and external customers.Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices, and policies with the ability to use them in complex varied situations.Teamwork: Ability to lead collaborative teams for larger projects or groups both internal and external to and across functional areas. Results have implications for the management and operations of multiple areas of the organizationCustomer Service: Ability to provide a high level of customer service to meet service level standards and expectations for the assigned department. Resolves service issues in the department in a timely manner.

Social/Environmental Requirements:

Work requires periods of close attention to work without interruption. Concentrated effort of up to 4 hours without break may be required.Work requires constant response to changing circumstances and using new information to adjust approach and to quickly respond to new needs. No substantial exposure to adverse environmental conditions.Health Care Status: NHCW: No patient contact. Health Care Worker Status may vary by department

Sensory Requirements:

Close work (paperwork, visual examination), Color vision/perception, Visual monotony, Visual clarity> 20 feet, Visual clarity feet, Conversation, Telephone.Physical Requirements:Sedentary work: Exerting up to ten pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally.This job requires constant sitting, Keyboard use. There may be occasional walking, standing.

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled