Experience and Education
Bachelor's in Business Administration or Public Administration is required; a Master's in Business or Healthcare is preferred; Preferred - Revenue cycle certification, certified healthcare financial professional, coding certification; six (6) years of relevant business experience in Billing, Revenue Cycle and Management for Medical/Surgical Follow-up and Denials Management is required.
- Oversee and streamline medical/surgical follow-up processes
- Develop medical/surgical follow-up functions and processes to ensure maximum workflow and productivity, communicating deficiencies as well as best practices to operations management.
- Monitor work queue aging and manage to meet MSRDP guidelines.
- Monitor denials management and determine corrective action plans.
- Supervise follow-up managers to ensure appropriate management and oversite of collections staff on a daily basis. Role include hiring, engagement, retention, schedule, monitoring productivity standards, departmental training, approving time off, processing payroll, performance appraisals, disciplinary actions, and exit paperwork.
- Assist the accounting department by approving all departmental bills for accounts payable and keep comprehensive records.
- Review denial and claims data on a regular basis to ensure accountability and follow-up.
- Work collaboratively with Director of Medical and Ancillary follow-up to establish and implement appropriate billing procedures, and procedures for follow-up on third-party approvals and collection of overdue patient accounts.
- Oversee denied, rejected and appealed claims to ensure proper follow-up and resubmission, if needed.
- Review and post weekly metrics for supervised staff to determine when operational goals are met.
- Communicate with leadership any trends/issues identified. Collaborate with contracting to resolve payor specific denial issues.
- Responsible for developing and maintaining data collection and issue reporting including but not limited to routine and special requests for department, management, administration and corporate offices within required timeframes.
- Serve as a resource to peers, staff and others, team leader, trainer as required, provides education, develops step actions, standards of performance and monitors and reinforces.
- Direct, monitor, assign, and evaluate work flows and processes in assigned areas. Work with other departments to ensure seamless process flow, and offer suggestions when a work flow needs to be corrected or changed.
- Assist in developing the Revenue Cycle Departments budget and provides fiscal direction to the unit.
- Other Duties: Performs other duties as assigned.