Manager, Professional Billing Operations

2 weeks ago

Houston, United States Memorial Hermann Health System Full time

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

**Job Summary**

**Desired Skill Sets**:

- 5yrs experience in a medical billing leadership role (manager or above)
- Must have EPIC experience - EPIC certification a plus
- Billing experience in a large healthcare system
- Must have knowledge of biller guidelines
- Must have knowledge of processing refunds
- Ability to engage with individuals of all levels
- Effective communication skills

**MINIMUM QUALIFICATIONS**

**Education**:Bachelor's degree in Healthcare Administration, Business Management, Accounting or related field preferred.

**Licenses/Certifications**:
Certification(s) preferred:

- Certified Professional Coder (CPC)
- Epic certification such as ARCR: Resolute Professional Billing Claims and Billing Readiness
- Project Management Professional (PMP)

**Experience / Knowledge / Skills**:

- Five (5) years of Physician/Professional Billing experience with at least three (3) years in a management level or supervisory position for a large health system required.
- Extensive knowledge and experience with Epic EMR system, specifically with EPIC Resolute Billing with a large health system.
- Comprehensive understanding of healthcare billing and payer guidelines.
- Strong communication skills and ability to successfully collaborate with team members across the organization at all levels.
- Strong problem solving and analyzing skills.

**PRINCIPAL ACCOUNTABILITIES**
- Manages all facets of professional billing revenue cycle processes to achieve and exceed best practice benchmarks.
- Monitors work queues and reports and actively seeks for areas of opportunity, deficiencies, and improvement strategies to minimize hold lag and improve accuracy of claims.
- Maintains awareness of billing rules and guideline changes and suggests billing component changes as necessary for payers.
- Maintains current working knowledge of billing systems, claim submission, remittance advices, and explanation of benefits, reimbursement methodology, payer systems, and payer requirements.
- Reviews/analyzes claim rejection report for payer patterns, rejection trends, assignment, and resolution pathways.
- Supports strategic plans to ensure the billing department is progressive and effective; works with other departments and practices to promote consistency in processes; stays up-to-date on all regulatory billing requirements; effectively coordinates work flow to ensure optimal quality of data and timely reimbursement.
- Creates and manages a strong culture of accountability and integrity.
- Ensures that the activities of the professional billing teams are conducted in a manner that is consistent with overall department protocol, Policies and Procedures, and are in compliance with Federal, State, and payer regulations, guidelines, and requirements.
- Supports plans and goals for continued improvement and service leverage acting as key leader to implement plans.
- Effectively communicates with all levels of managers and staff, and actively participates in performance management initiatives.
- Maintains a positive cooperative relationship with all groups across billing and non-billing areas. Sets a positive example in collaborating initiatives, identifying solutions, measuring, and sharing results and providing specific feedback.
- Uses analytical approach to problem solving using quantified data and measurable results to reach sound conclusions.
- Reviews analyses, reports, KPIs, and operational metrics. Participates in corrective actions in response to variance and trends.
- Ensures the recruitment, training, and retention of motivated, competent supervisors, and billing specialists; establishes goals and standards for performance appraisals.
- Provides, oversees, and/or coordinates the provision of training for new and existing staff on applicable operating policies, protocols, systems and procedures, standards, and techniques.
- Manages productivity and quality of output from the team through data, usage, and reports.
- Oversees management of appropriate personnel, providing recommendations for hiring, promotion, salary adjustment and personnel action.
- Guides individuals and groups toward desired outcomes, setting performance standards and delivering leading quality services.
- Manages staffing levels and productivity. Provides team communication regarding department updates, organizational activities, financial performance, education

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