Location: Kent Campus Hospital

Status: Full Time 80 Hours

Shift: Days

SALARY RANGE: 82,950.40 - 128,564.80YEARLY

General Summary:

Responsible for directing, coordinating, and planning of staff for insurance AR, to ensure efficient and proper billing, account follow-up, account collections, and reconciliation of patient accounts. Must work collaboratively with Employed Physician Practices, Revenue Cycle, and other relevant departments to ensure compliant billing. Adhere to internal controls for applicable state/federal laws, and the program requirements of accreditation agencies and federal, state, and private health plans. Leads by example, upholding all Bayhealth values and holding team members and payers accountable. Ability to work independently and meet established deadlines, develop reports, and quantify denial issues impacting AR performance. Excellent communicator and agent for change.

Responsibilities:

1. Supervises the assigned team and team members engaged in the department. This includes interviewing, hiring, performance evaluation, training and disciplining all system support personnel. Delegates tasks as determined appropriate.
2. Provides a goal-oriented work environment, establishing clear and concise work procedures expectations. Develops and plans goals and objectives for the department with PFS Leadership Team. Measures financial and operational performance, maintains monitoring and reporting systems. Audit, trend and benchmark billing/collection functions.
3. Manage Accounts Receivable for all insurance AR billed in the Epic HB and PB modules to minimize financial losses to Bayhealth. Ensures adherence to all governmental and commercial payor rules, regulations, and Bayhealth Corporate policies and procedures. Ensures that accounts receivable activities are meeting productivity, quality, reimbursement goals and all reimbursement options have been exhausted. Monitors vendor performance, as appropriate for any insurance AR vendors. Review and respond to patient complaints, legal documents following appropriate customer services, and internal policies.
4. Complete monthly rounding on direct reports; maintain individual rounding logs and stop light reports to facilitate communication. Promotes employee engagement for individual teams and the department striving for continues improvement.
5. Responsible for monitoring performance and resolution of all insurance credit balances.
6. Reviews quality assurance review results with staff providing as necessary education/training to address opportunities for improvement.
7. Contributes to development of education materials for new hire and annual training competencies
8. Monthly reporting requirements: AR performance for large payers, physician practices, and vendors. Communicates performance issues and actions being taking to resolve the issues. As appropriate escalates to State and Federal agencies when payers are not adhering to regulations.
9. As applicable, maintains all Epic ARCR certifications in good standing.
10. Reviews all requests for system changes to determine the impact on payers and processes under the position's span of control. Ensures supporting research and documentation supporting the change request are accurate and have been properly validated.
11. Responsible for access requests and maintenance including, but not limited to Medicare Novitasphere and Medicaid portals.
12. All other duties as assigned within the scope and range of job responsibilities.

Required Education, Credential(s) and Experience:

• Education: Bachelor Degree
  ; Business
  ; In lieu of a bachelor's degree, will accept a High School Diploma or GED with eight (8) years of Revenue Cycle Progressive leadership experience (Four years of experience for a verified associate's degree.)
• Credential(s): None Required
  ;
• Experience: Required: Five years in patient accounting, third-party reimbursement, or related field, to include a minimum of three (3) years of experience in a supervisor or leadership role.
  Preferred: Seven years in patient accounting, third-party reimbursement, or related field, to include a minimum of five (5) years of experience in a supervisor or leadership role.

Preferred Education, Credential(s) and Experience:

• Education:
• Credential(s): Certified Patients Account Manager
  Certified Revenue Cycle Representative
• Experience:

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