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Revenue Cycle Denials Manager
2 months ago
At Central Maine Healthcare our team members are committed to providing exceptional care and experiences for our community and for each other every day.
Position Summary: The Manager Patient Financial Services is responsible for strategic and operational leadership of the Patient Financial Services department. This position contributes to the financial strength, compliance and overall performance of Revenue Cycle operations by providing leadership for all Patient Financial Services functions, including hospital and physician (provider) services. The Manager Patient Financial Services serves in a key role to monitor and facilitate improvement in the overall quality, timeliness, completeness, and accuracy of Patient Financial Services processes (such as claims processing, payment variances, payment posting, accounts receivable management, financial counseling, and customer service), as well as effectiveness of Patient Financial Services policy, practices and technology platforms.
The position will provide overall administration, direction, coordination, and evaluation of Patient Financial Services and is specifically responsible for the following:
1. Claims Processing
2. Claims Edit Management (DNFB)
3. Payer Analytics
4. Accounts Receivable Management
5. Payment Variance Resolution, including Patient and Payer Credits
6. Patient Follow Up
7. Payment Posting & Reconciliation
8. Customer Service
9. Collections
10. Vendor Management
11. Denial/Edit avoidance, mitigation and timely resolution
It is critical that this position be highly effective in delivering the services described above and work harmoniously with leaders and staff across the organization. Effectiveness will be measured in terms of measurable results, commitment, staff engagement and customer satisfaction (at all levels).
Job Functions and Duties:
1. Support strategic direction and oversee the operation and process design of systems and procedures to ensure efficient functioning of Patient Financial Services.
2. Participate in development of industry best practice operating procedures with consistent application in all business units.
3. Ensure all compliance and regulatory standards are maintained.
4. Develop, monitor and manage operations utilizing industry metrics on a monthly, annual and long-range planning basis. Ensure development of metric report cards to quantify improvements in productivity, quality, service and overall financial results.
5. Serve as an internal consultant on patient financial issues including 501(r), pricing transparency, compliance with payer contracts, and any other regulatory or contractual requirements.
6. Active participation in denial mitigation and revenue preservation activities.
7. Achieve annual and periodic goals and key performance indicators in support of Patient Financial Services operations and overall financial performance.
8. Manage, prepare and present budgets that demonstrate prudent use of the organization’s resources. Achieve planned results for Patient Financial Services operations.
9. Ensure effective coordination with Director Patient Financial Services and other Revenue Cycle Managers to achieve financial and service level goals for the Patient Financial Services business units as well as Central Maine Healthcare.
10. Ensure effective communication and coordination with other functional areas to achieve desired service levels.
11. Participates in drafting and final approval processes for Patient Financial Services policies and procedures.
12. Collaborates with patient service leaders to ensure that processes are working effectively, efficiently and accurately.
13. Evaluate appropriate and key outsourcing partnerships such as AR vendors.
14. Monitor and support daily staff functions in all areas related to the scope of the Manager’s responsibility.
15. Ensure strong technology functionality to support all elements of Patient Financial Services as it relates to revenue cycle and interfaces with clinical and other operational areas. Examples are denials, underpayment, claim scrubbing, AR collections and propensity to pay tools.
16. Communicates with other leaders to establish accountability and coordination between Patient Financial Services and other departments.
17. At the direction of the Director of Patient Financial Services, provide formal reports and presentations to management teams, physician groups, external businesses and consumer groups.
18. Assist with special analysis and projects as needed.
19. Provide leadership support at all supported entities within CMH.
Technology:
20. Seek and recommend new information technology solutions and or manual changes that support Patient Financial Services departmental functions.
21. Work collaboratively with departmental personnel to implement systems and process changes aimed at improving Patient Financial Services performance.
22. Ensure compliance with outside regulatory requirements are documented (i.e. 501(r), Financial Assistance, Billing and Collection)
Management Reporting and Monitoring:
23. Review and analyze on-going Patient Financial Services KPI’s based on computer generated data and manual reports.
24. Utilize departmental work plans to monitor initiative and project goals, progress, and outcomes.
Human Resource Management:
25. Responsible for the selection and development all staff reporting under the Manager Financial Clearance:
Assists in ongoing educational and professional growth of all direct reports
Facilitates staff growth in position expectations
Assists in the provision of a comprehensive orientation and annual/ongoing competency validation to assure proficiency in performing assigned tasks based on developmental needs
Ensures staff compliance with hospital expectations
Actively participates in counseling, documenting deficiencies and setting improvement objectives; monitors and document progress on performance improvement plans
Completes annual performance evaluations within specific time limits
Supports all affiliated student programs
26. Performance Management, will actively
Timely completion staff evaluations
Screening and hiring new staff
Work with staff to set goals
Implement continual performance development
Monitor staff for fitness for duty
Initiate corrective actions
27. Staff Retention will actively:
Assesses staff satisfaction
Working with the Director to implements strategies to address satisfaction issues and promote retention
Working with the Director to identify methods to reward and recognize staff
28. Staffing needs:
Work with the Director in the evaluation of staffing patterns and needs
Identify opportunities to matches staff competency with role expectations
Manages human resources within scope of labor laws
Training & Education:
29. Direct ongoing programs for staff development and training that foster and mentor the next generation of Patient Financial Services leaders. Establish goals with direct reports for organizational and personal development.
Professional Development:
30. Attend local, regional and national conferences/seminars to remain current in supporting the needs of the organization.
31. Review industry publications to maintain knowledge base and stay current on best practice solutions.
32. Maintain current knowledge of regulatory developments involving agencies (CMS, AHA, DHS, and Joint Commission.)
33. Maintain certifications as applicable
34. Maintain membership with professional associations (HFMA, AAHAM, etc.)
Note: the duties listed above reflect the majority of the duties of this job and does not, nor is it intended to, reflect all duties that may be required for an incumbent in this job to perform.
Communication:
35. Maintains awareness of verbal/ nonverbal communication in interactions with staff, other departments, physicians (providers), patients, families and students
36. Collaborates and communicates effectively with all members of the health care team; shares information to ensure staff, physicians, and affected departments are aware of unit changes
37. Maintains patient, staff and hospital confidentiality in all communication interactions: written, verbal, electronic and digital
38. Demonstrates ability to initiate and manage crucial conversations and coach leadership team/staff in same; resolves and manages conflict
39. Utilizes daily huddles to keep channels of communication open. Gives appropriate feedback in a timely manner to questions and concerns.
Customer Service:
40. Displays positive attitude. Treats others with honesty and respect. Speaks positively in all customer interactions internal and external.
41. Assesses customer service by reviewing and responding to patient satisfaction
Education and Experience:
12. Bachelor’s Degree preferred, Associated Degree required or Four (4) years progressive, relevant knowledge toward mastery in the field accepted in lieu of degree, and
13. Five (5) years of progressively responsible management level experience in a similar size and scope organization or system in Revenue Cycle.
Knowledge, Skills, and Abilities:
14. Detailed knowledge of privacy and security regulations, confidentiality / HIPAA, payer registration /authorization requirements, State Charity Care compliance, and MaineCare compliance regulations.
15. Working knowledge of Medical Terminology, Current Procedural Coding (CPT, HCPCS), Diagnostic Coding (ICD-9, ICD-10).
16. Expertise with regulations and accreditation standards, knowledge of specific state and federal requirements and standards.
17. Working knowledge of Medical Record, Financial Services and Healthcare Application technology.
18. Demonstrated experience in diagnosing, evaluating and developing corrective actions for problems in operations.
19. Able to effect collaborative alliances and promote teamwork.
20. Ability to ensure a high level of employee, patient, visitor, and external stakeholder satisfaction.
21. Effective organizational, planning, controlling, scheduling and project management abilities.
22. Effective managerial and administrative abilities as applied to the management of multiple projects.
23. Effective leadership abilities.
24. Ability to positively influence change.
25. Excellent communications skills, both oral and written.
26. Demonstrated ability to work well with diverse people, excellent human relation skills.
27. Flexible and able to react to ever changing priorities.
Physical Environment:
28. Most duties do not generally present an occupational risk, however, failure to follow standard procedures and safety rules may expose the employee to potential injury e.g. falls on slippery floors, etc.
Physical Requirements:
29. Must be in good physical condition to meet the demands of an active position including moderate walking, sitting, standing, twisting and moderate hand/wrist motion.
If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application
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