Job Description

Job Description

Job Description

ESSENTIAL FUNCTIONS

• Manages the day-to-day operations of the billing department to maximize net revenues and cash flow by managing all aspects of the revenue cycle while ensuring adherence to policies and procedures.

• Monitor accounts receivable activity and initiates appropriate corrective measures as needed.

• Communicates performance data and associated action plans to Senior Leadership.

• Identifies and implements processes to achieve key revenue cycle metrics including but not limited to a/r days, unbilled a/r, denial percentage, and cash collections.

• Analyze large volumes of data and provide financial analysis and regularly presents trends, movements, and status to Senior Leadership.

• Review billing work queues regularly to ensure that workloads are distributed evenly, and that the department metrics are being met.

• Resolve complex patient, physician, and other issues when necessary.

• Manages self-pay receivables including vendor relationships to help resolve AR. Inclusive of self-pay receivables is the process of charity review and bad debt management.

• Develop and implement policies and procedures for designated areas; evaluate new systems and methods and recommend changes as necessary.

• Communicate with payers and know when and how to escalate payer issues.

• Oversee the hiring, training, and supervision of department personnel.

• Maintains comprehensive knowledge of 3rd party billing requirements and reimbursement principles. Also maintains comprehensive working knowledge of payor contracts and ensures that payors are billed according to contract provisions.

• Conducts regular meetings with staff to discuss third-party reimbursement methodologies. Provides direction to staff on changes in managed care reimbursement and expectation of changes in insurance guidelines.

• Keeps abreast of compliance regulations, standards, and directives regarding governmental/regulatory agencies and/or third-party payers. Ensure communication and education of such to the Billing department as well as other Revenue Cycle Leaders.

• Must be able to meet deadlines given by Manager or Senior Leadership.

• Research and resolve discrepancies in a timely manner.

• Works with sensitive and confidential materials and must be able to exercise discretion.

• Verifies and updates patient registration information in the practice management system.

• The job holder must demonstrate current competencies for this position.

EDUCATION

• High School diploma or equivalent working knowledge preferred.

• BA/BS in Business Administration, Accounting, Finance or equivalent is preferred.

EXPERIENCE

• A minimum of five years of experience in a leadership role within a billing department in healthcare revenue cycle operations.

• Prefer experience working with multiple physician specialties.

• Previous supervisory experience and strong leadership skills with an ability to motivate with a positive attitude that positively impacts others.

REQUIREMENTS

• Demonstrated successful healthcare revenue cycle leadership experience.

• Experience analyzing and trending financial data.

• Excellent written and verbal communication and presentation skills.

• Excellent critical thinking, troubleshooting, and analytical skills.

• Excellent interpersonal skills including conflict management.

• Experience working in Excel (advanced formulas, pivot table)

• Well organized and able to meet deadlines.

• Excellent attention to detail.

KNOWLEDGE

• Knowledge of claims processing and editing systems.

• Strong knowledge of Medicare and Medicaid payer guidelines across multiple states.

• Knowledge of CPT, HCPCS, and diagnosis coding.

SKILLS

• Skill in effective data collection and analysis.

• Interpersonal skills essential to communicate effectively, written and oral, with internal and external personnel at various levels.

• Skill in effectively managing multiple projects simultaneously.

ABILITIES

• Ability to multi-task and work well under pressure.

• Ability to analyze problems and interpret information and to prioritize and reprioritize, as necessary.

• Ability to work independently, and as part of a team.

• Ability to read and interpret payer contracts.

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment.

• Extended work hours at or near month end to meet department objectives may be necessary.

PHYSICAL/MENTAL DEMANDS

• Requires sitting and standing associated with a normal office environment.

• Some bending and stretching are required.

• Manual dexterity using a calculator and computer keyboard.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.

At Center for Bone & Joint Surgery , we are dedicated to taking care of you so you can take care of business! Our robust benefits package includes the following:

• Competitive Health & Welfare Benefits
• HSA with qualifying HDHP plans with company match
• 401k plan after 6 months of service with company match
• Employee Assistance Program that is available 24/7 to provide support

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