POSITION PURPOSE
Analyzes performance metrics and provides consultation, leadership, and direction to enhance front-end workflows and improve revenue performance for THMG. Leads complex projects for practice/clinic locations with focus on ongoing support and continuous improvement. Serves as a consultative resource and develops, establishes, and manages relationships with executive leaders, key stakeholders, high-level professionals, and decision-makers. Makes routine site visits, conference calls, and regularly communicates with assigned practices/clinics.
ESSENTIAL FUNCTIONS
Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
Collaborates with assigned site location(s) front office and billing colleagues to improve revenue cycle performance by reviewing weekly metrics, assessing root cause analysis, and developing/implementing action plans.
Reviews front-end denials (eligibility, registration, and authorizations) for each area and provides feedback to Directors, Practice Managers and Supervisors. Provides trended metrics to help identify areas that are performing well and areas that need further development/review.
Oversees, assists, and manages Registration Charge Review and Claim Edit workqueues.
Reviews Front Office Dashboard for significant variances between performance & benchmarks or noticeable drops in performance from one week to the next.
Develops and conducts general or specialized educational sessions for colleagues or providers, such as Billing 101 sessions.
Conducts quarterly quality assessment of registration accuracy performed by front-end users. Provides education and training to those not meeting best practice goals.
Provides recommendations for communications and helps complete monthly newsletters informing practice colleagues and physicians of insurance policy and regulatory changes and changes in CPT, ICD-10 and HCPCS coding.
Communicates with manager and liaison team to ensure all assigned sites and colleagues are supported for all areas of revenue cycle.
Participates and leads Revenue targeted projects and addresses opportunities and barriers as they arise.
Provides regular project status updates to customers and leadership especially when there are delays or challenges.
Attends additional training, performs research, e-learning to stay current on best practices and new practice management technology and functionality as it becomes available.
Supports new practice acquisitions by conducting current-state assessments on front office functions, documenting gap assessments, making recommendations to transition to future-state, and providing go-live support.
Documents lessons learned to develop payer and/or billing playbooks for all specialties.
Conducts new leader training and provides educational tools and guidance to support front office best practices. Agenda items include front office dashboard review and role expectations.
Communicates effectively with colleagues to ensure coordinated efforts between Revenue Integrity, EPFS, and offices.
Serves as a subject matter expert in all areas of revenue and acts as a primary contact for assigned site or colleagues for questions and assistance.
Maintains knowledge of practice management system, office responsibilities and billing process.
Maintains knowledge of and supports revenue standards and procedures.
Researches and stays current on managed care/insurance updates.
Assists with special projects as needed and performs other duties as assigned.
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.
MINIMUM QUALIFICATIONS
Must possess a comprehensive knowledge of professional billing, as normally obtained through bachelor's degree in healthcare administration, Business Management, Accounting, or a related field, and/or 7(seven)-10(ten) years of professional billing experience.
MA, MGMA, AAPC or other healthcare certification preferred.
Six Sigma or LEAN certification preferred.
Required: Experience/knowledge of electronic practice management systems.
Previous leadership in a related area preferred.
Knowledge of organization policies and procedures.
Knowledge of practice management systems for billing and office procedures.
Knowledge of managed care and insurance practices.
Understanding of insurance claims and billing process.
Understanding of HMO, PPO, TPA and commercial insurance types.
Understanding of fee schedules and pricing.
Experience with office processes and procedures.
Ability to develop and maintain effective relationships with medical and administrative staff, patients, and the public.
Ability to communicate effectively both verbally and in writing.
Ability to establish priorities, coordinate activities and work independently.
Ability to facilitate development of educational sessions through knowledge of adult learning styles.
Ability to work independently and with minimal supervision. Ability to work in a team environment providing support to multiple positions. Ability to resolve problems and complete assignments accurately and promptly.
Ability to develop and maintain training manuals and written processes.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.