Full Job Description
Position Summary:
Reporting to the Senior Director of Healthcare Operations in the School of Podiatric Medicine (TUSPM), the Manager-Finance and Accounting (Patient Billing and Credentialing) ensures that cash receipts from patient services are maximized by credentialing clinical faculty members, billing and collecting fees for service in compliance with policies and procedures established by federal and state government regulatory agencies, third party payers, Temple University Health System's Office of Compliance and TUSPM in an accurate and timely manner.
Job Details:
* This position requires the following background checks: criminal history review
Required Education and Experience:
* Bachelor's degree and at least 4 years of experience in Healthcare Administration, Accounting or Finance.
* At least 3 years of high-volume healthcare billing/collection office supervision required
* Advanced knowledge of medical terminology, Medicare, Medicaid, and commercial insurance billing regulations required
* An equivalent combination of education and experience may be considered.
Preferred Education and Experience:
* Certified Professional Coder (CPC) designation by the American Academy of Professional Coders (AAPC) preferred
* Podiatric medical billing experience preferred.
Required Skills and Abilities:
* Must be organized, detail oriented, able to work independently and to complete tasks in a timely manner.
* Must have a customer service orientation and the ability to interact with professionalism and tact under stress.
* Must be proficient with applications such as Microsoft Office, electronic health record/patient management systems and be able to adapt to new technology.
Essential Duties:
Each function requires that the Personally Identifiable Information (PII) of students, donors, alumni, employees and the protected health information (PHI) of patients be safeguarded at all times from unauthorized use or dissemination as governed by the Health Insurance Portability and Accountability Act (HIPAA), the Gramm-Leach-Bliley Act (GLBA), the Family Educational Rights and Privacy Act (FERPA), as well as other related laws and Temple University policies.
Credentialing:
* Prepare and transmit all necessary documents to the Centers for Medicare and Medicaid Services (CMS), the Pennsylvania Department of Human Service for Medicaid Revalidation, the Council for Affordable Quality Healthcare (CAQH) and cognizant third-party payers to establish or maintain TUSPM, its satellite facilities and individual clinical faculty members' participation in associated health insurance plans for podiatric medical services/procedures, radiological services, physical therapy care and ambulatory surgical facility fees.
* Review and update credentialing information as required by CMS and cognizant third party payers for TUSPM and its individual providers on not less than a monthly basis.
* Maintain and secure credentialing files electronically.
Billing:
* Verify that all charges for health services activity are entered completely and accurately prior to the processing and submission of insurance claims and patient statements in compliance with policies established by CMS, cognizant third party payers, Temple University Health System's Office of Compliance and TUSPM administration.
* Reconcile data entry related to health services charges by batch identifiable to the input operator or billing provider within one (1) business day of entry, if applicable.
* Ensure that all initial and revised insurance claims are processed via electronic submission and/or in paper form daily, but not less than three (3) times per week; individual patient statements are processed at least once per month.
Collection:
* Verify that all cash received from health services activity is deposited via lockbox or at the TUSPM Office of Cash Operations within one (1) business day of receipt.
* Verify and reconcile data entry related to health services cash receipts by batch identifiable to the input operator within one (1) business day of entry, if applicable.
* Verify that all denied and underpaid claims for health services are investigated such that legitimate claims are adjusted and re-billed as soon as possible, but not longer than ten (10) business days after denial.
* Reconcile and arrange for the transfer of cash collected by other Temple units on behalf of TUSPM and vice-versa not less than monthly.
* Ensure that contractual allowances and write-offs for bad debt are recorded in an accurate, timely manner in compliance with TUSPM Policy.
* Review patients' accounts with credit balances not less than monthly and process refunds or escheats, where appropriate.
* Analyze collection patterns not less than monthly to discover and correct errors identified to third party payers, clinical providers, senior billing clerks or practice management software functionality.
* Maximize Collection Percentages (gross and net) and minimize Days Charges in Accounts Receivable according to goals established in consultation with the Senior Vice Dean for Finance and Administration and the Senior Director of Healthcare Operations.
* Review and enforce adherence to the TUSPM Cash Handling Policy and related policies established by Temple University for the protection and recording of health services cash receipts.
* Ensure that accounts are designated for transfer to contracted collection agencies as required by TUSPM policy.
* Monitor collection agency effectiveness and the accuracy of charges for their services on not less than a monthly basis.
* Prepares analytical reports on collection activity as required by TUSPM management, Temple University administrators, and applicable third parties.
* Ensure that all face-to-face and telephone inquiries relative to billing, collection and compliance are addressed in a timely, courteous manner.
Administrative:
* Hire and supervise members of the Patient Billing Department, in consultation with the Senior Director of Healthcare Operations.
* Establish goals, monitor performance and communicate plans for improvement for members of the Patient Billing Department using interpersonal communication, written policy development and the Temple University Performance Development System (PDS).
* Interface with clinical faculty, administrators, third party insurers, patients and other Temple units to resolve billing/collections issues and improve internal processes.
* Initiate requisitions for office supplies, services and equipment for Patient Billing Department using on-line and/or manual systems in accordance with Temple University and TUSPM policies.
* Verify receipt of purchases, as required.
* Coordinate the month-end closing of the practice management system with TUSPM's Department of Fiscal Affairs.
* Prepare ad hoc reports, as required.
* Arrange in-service training for clinical faculty members, students and staff, as appropriate, regarding new and/or revised billing and collection procedures.
Facilities Support:
* Arrange repairs and service of department equipment as required, in accordance with Temple University and TUSPM policies.
* Report dysfunctional and/or hazardous systems, facilities or major equipment to the TUSPM Area Facilities Manager, Director of Information Technology or the Associate Dean for Finance and Administration as appropriate.
* Serve on the TUSPM Health Services Compliance Committee to ensure that billing and collections procedures are consistent with compliance requirements.
* Other duties as required by the TUSPM Senior Director of Healthcare Operations.
