Position Summary

Responsible for supervising, planning, organizing and coordinating the daily activities of the claims processing and accounts receivables for the Acute Care billings (hospital) under the direction of the Director of the SBO. . Maintains an efficient billing process for all hospital ancillary areas. Maintains best practices with registration, billing, denials, payment posting and collection follow up processes using HFMA data. Interface with and direct front end Ancillary Hospital Depts. to promote optimum patient service experience including confirming patient’s insurance at time of service.  Ensure strong protocols and oversight is in place for the timely submission of chart documentation by providers such that a timely bill can be dropped for the insurer and patient (if any additional out of pocket payments are required).  Ensure that any required edits on the billing side are done timely so that there is little to no delay between a bill being dropped. Oversees; the quality of registrations, timeliness of billings, reduction of denials and completion of payment posting. Ensures adequate staffing for the department; evaluates quality of performance against HFMA benchmarks and defined KPIs.  Manage staff to meet or exceed the established KPI’s by role and responsibility.

Primary Position Responsibilities

In conjunction with the Admin Director, implements, oversees and maintains an efficient billing and collection process. Establishes workflows including detailed development of tasks within Affinity and any other supplemental systems to manage and continuously improve the quality and productivity of Acute Care billing. Oversees the oversight of the quality of registrations, timeliness of billings, reduction of denials and completion of payment posting for all Billing and Follow up for all staff involved in the processes (including monitoring the productivity and quality).  Responsible to evaluate each staff member for quality of performance and adherence to KPI standards. Ensures all personnel involved in billing and collection activities are trained to perform their assigned tasks. Works with Hospital Dept. leaders to ensure all billing policies are followed in addition to providing comprehensive feedback when denials are received within their areas. Works with Dept. Leads, Leadership, Case Management and Revenue Integrity to ensure that the appropriate insurance information along with other required Billing information is obtained and provides feedback and education when data/information is omitted. Serve as a thought leader and subject matter expert in denial management, revenue cycle optimization, and healthcare finance. Stay abreast of industry trends, best practices, and emerging technologies through active participation in professional associations, conferences, and educational forums Oversees Billing Scrubber Software a) assures bills are going out timely and monitors all billing edits for backlogs and trends b) Communicates missing information in a timely manner to the appropriate areas c) Trains Billing Specialists within Billing Software and identifies trends in order to correct “root cause” issues; d) Reviews diagnosis and CPT coding with coder and interfaces with Charge Master (CDM) specialist to ensure that all required CPT codes are accounted for within the master charge master file. Tracks AR days, denials, appeals, and recommends policy and procedure changes to reduce and prevent denials, maximize cash flow and reduce accounts receivable. Member of the Revenue Cycle Steering committee and subcommittees as appropriate. Seeks to improve customer focused professional and patient satisfaction based on patient satisfaction surveys, complaints and other feedback. Addresses all patient complaints within 48 hours. Shares ideas, information and knowledge with others through mentoring and coaching of staff and colleagues, proactively seeks opportunities to give directions, answer a question, or provide information or reassurance to customers; Acts as a liaison between all key stakeholders in the billing process including the Billing Dept., HIM, Case Management and all other respective Hospital depts. Conducts monthly staff meetings in conjunction with staff to review performance, billing issues and updates, and anything else related to the improvement of the billing cycle processes. 

Qualifications

Minimum Education: Required: High School Diploma or Equivalent Certificate and/or Advanced Specialized or Technical Training within the Revenue Cycle Preferred: Bachelor’s Degree in business, operations, or healthcare preferred
Minimum Years of Experience (Amount, Type and Variation): Required: Minimum 7 years medical billing experience Chargemaster experience required Experience working with Medicare, Medicaid, and private insurance contracts – understanding and interpreting for ambulatory billing practices Experience with Denial Management in Hospital or related setting.  Preferred:  Experience with hospital and ambulatory billing systems such as Epic, Affinity, NextGen, Ingenious Med (Imed), and third party claims clearinghouse vendors.
License, Registry or Certification: Required: None Preferred: Billing Compliance, CRCR
Knowledge, Skills and/or Abilities: Required: Demonstrates strong analytical skills. Demonstrates strong written and verbal communication skills (Word/Excel (Pivot tables and analyzation of large amount of data) Demonstrates ability to interact successfully with staff at all levels of the organization. Demonstrates ability to work independently in a productive, goal-oriented manner Preferred: Knowledge of EPIC, Billing Software modules