Job Description

This is a Business Office Manager position.

Location/Department: Business Center - Business Office

FT 80/pp

Job Summary:

The Patient Financial Services (PFS) Manager will evaluate business processes, anticipate requirements, uncover areas for improvement, & develop & implement solutions across the department. Additionally, this position will lead the design, development & implementation of best practice guidelines within systems &/or policy & procedures to achieve workflow efficiency across the department. Successful candidates will be able to access & manipulate data, possess critical thinking skills & will possess an ability to guide & train PFS staff in the completion of projects across the department.

Responsible for hospital & physician accounts receivable (AR) management to ensure timely billing & collections of insurance & patient revenue. Project manages various system implementations, provides team member training & education, responsible for providing regular project updates to management, must have strong analytical skills & will be responsible for providing analytical & technical problem resolution to issues & barriers while ensuring project risks have been mitigated. Will investigate, update, & provide necessary documentation to insurance/third party liability carriers on all open receivable accounts in a timely manner. Responds to emails & patient inquiries within 24 hours. Performs detailed review of Aged Trial Balances by payer as assigned. Investigates all denied claims & works with appropriate individuals to appeal as necessary. Provides support to Patient Account Reps to ensure efficiency, adherence to processes & workflows, to ensure quality performance levels.

Supervisory Responsibilities: Business Office staff

Duties/Responsibilities:

Leads the analysis implementation & maintenance of revenue cycle best practice processes & activities across the department & ensures goal setting & project tracking.
Develops & monitors staff work queues & productivity to ensure work volumes & staffing are aligned.
Audits staff work & participates in developing & delivering training programs within the department.
Creates system & processes audit plans. Resolves discrepancies, as required.
Troubleshoots issues & resolves concerns, as well as recommends necessary fixes. Advises management of results & recommends actions.
Prepares data analysis for departmental leadership in organized format to clearly convey trends & identify key areas for revenue optimization.
Creates reports to evaluate accounts receivables, operational productivity & departmental outcomes.
Analyzes data trends to determine the root cause & conducts deep dive sampling.
Provides a detailed assessment of revenue cycle processes with a focus on process improvement & best practices.
Monitors & tracks ongoing departmental performance through key performance indicators (KPI) in comparison to industry benchmarks.
Cultivates effective collaborative relationships with departmental teams to seek resolution of issues identified through monthly monitoring of KOIs/KPIs.
Works closely with department management to facilitate root issue remediation. Collaborates closely with peers to develop, validate, & maintain meaningful report sets.
Maintains knowledge of Medicare, Medicaid & commercial reimbursement. Stays abreast of group payer contracts, payer policies, payer plans, & member benefits. Keeps apprised of rules & regulations affecting reimbursement.
Manages special projects & duties as needed or assigned.
Serves as first point of contact & support for staff on billing & collection questions.
Manages staff schedules, approves timecards, tracks attendance, handles PTO requests & fills in when staff is unavailable.
Responsible for orienting & training all new team members.
Participates in interviews & hiring process.
Assists in preparation of annual performance reviews for staff.
Supports/conducts departmental huddles, staff meetings & communications.
Able to communicate effectively with staff & the public in person & over the phone under stressful situations.
Keeps Director informed of appropriate matters.
Management & supervision of AR clean-up projects.
Management of internal processes & workflow implementation.
Assists in development & revision of departmental policies & procedures.
Conducts research & resolution activities on insurance claims.
Track & trend revenue cycle data including, but not limited to, staff productivity, denials, clean claim rates & bad debt.
Management & supervision of project/program implementation.
Assists the Director of Revenue Cycle to identify & implement solutions & system wide education.
Maintains, updates & reports KPI.
Functions as the program coordinator of the Indiana Navigator program.
Obtain & maintain certification from the State of Indiana Navigator's program.

Required Skills/Abilities:

Strong customer service, time management & decision-making skills.
Able to multi-task; detail oriented.
Highly organized, self-starter.
Demonstrated analytical skills-ability to break down & quantify problems & processes.
Excellent written & verbal communication skills.
Demonstrated ability to manage a process & timelines effectively.
Must be able to operate a computer & other basic office equipment.

Education and Experience:

Bachelor's degree in Accounting or Finance, Health Information Management, Health Administration, Computer Science or related field (in lieu of degree, at least 10 years healthcare revenue cycle experience.)
Minimum of 5 years revenue cycle, medical billing or follow-up experience.
Minimum of 3 years relevant supervisory experience; revenue cycle supervisory or managerial experience preferred.
Medical Coding Certification through the American Academy of Professional Coders (AAPC), and/or the American Health Information Management Association (AHIMA).
Coding or billing experience required; Certified Revenue Cycle Representative (CRCP or CRCR) preferred.
Cerner/Cerner Community Works experience & expertise preferred.
Proficient in MS Office Suite including Excel, Word, Visio, & PowerPoint.
Knowledge of patient accounting systems, contract management &/or claims scrubber software.
Experience reporting from healthcare decision support, patient accounting, contract management &/or claims scrubber systems.
Knowledge of CPT, HCPCs & ICD-10 coding principles.
Expert knowledge of inpatient & outpatient billing requirements (UB-04, 837i); specifically, how claims information impacts & drives reimbursement.
Expert knowledge of Medicare, Medicaid & commercial reimbursement methodologies.
Beginner to intermediate proficiency in database reporting queries.

Physical Requirements: