Revenue Cycle Manager – Physician Billing

3 weeks ago

Wilmington, United States ChristianaCare Full time

Do you want to work at one of the Top 100 Hospitals in the nation? We are guided by our values of Love and Excellence and are passionate about delivering health, not just health care. Come join us at ChristianaCare

ChristianaCare, with Hospitals in Wilmington and Newark, DE, as well as Elkton, MD, is one of the largest health care providers in the Mid-Atlantic Region. Named one of “America's Best Hospitals by U.S. News & World Report, we have an excess of 1,100 beds between our hospitals and are committed to providing the best patient care in the region. We are proud to that Christiana Hospital, Wilmington Hospital, our Ambulatory Services, and HomeHealth have all received ANCC Magnet Recognition®.

PRIMARY FUNCTION: 

Oversee the daily activities of the Physician Billing operation. Uses knowledge of revenue cycle principles to ensure accurate and compliant billing.

PRINCIPAL DUTIES AND RESPONSIBILITIES:   

  • Provides overall management and direction of daily duties related to pre-bill editing, claims management, AR follow-up, denial management, employee education, training, and compliance controls.

  • Reviews detailed monthly dashboard reports for each entity, including AR balances, denial trends and key performance indicators and takes appropriate action to ensure department/organizational goals are being met.

  • Works collaboratively with other billing managers, CCHS department managers, executive leadership, and outside agencies regarding identification of issues along with resolution to ensure timely, accurate billing and reimbursement.

  • Monitors caregiver productivity and performance.  Provides feedback and takes appropriate action when necessary.

  • Files appeals as needed with third party payers and other external agencies.

  • Recognizes and resolves issues pertaining to contracts and improper billing procedures.

  • Builds and maintains a close relationship with payer provider representatives to ensure proper claim processing.

  • Maintains comprehensive knowledge of regulatory requirements related to third party billing rules.

  • Responds to inquiries with regards to CMS policies, third party payer guidelines, and billing department protocols and advises physician practice staff accordingly.

  • Reviews communications received from third party payers and shares information with impacted personnel.

  • Prepares and revises policies and procedures as warranted and conducts in-service/meetings with caregivers.

  • Safeguards the integrity of billed accounts by ensuring compliance with billing, documentation, and coding standards.

EDUCATION AND EXPERIENCE REQUIREMENTS:

  • Bachelor’s Degree in Health Care Administration, Accounting, or Business.  Relevant experience may be considered in lieu of a 4-year degree.

  • Certified Professional Coder (CPC) preferred

  • Soarian Financials/Millennium experience preferred

  • Five years of physician/medical collections experience with at least three years in a progressive management role

  • Must have extensive 1500/837p billing experience

  • Must have proven experience with HMO, PPO, and governmental insurance plans’ payer rules and contractual language.

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