Specialty Billing Operations Manager
2 weeks ago
About NYC Health + Hospitals:
Empowering Every New Yorker — Without Exception — to Achieve Optimal Health
NYC Health + Hospitals stands as the largest public healthcare system in the United States, delivering vital outpatient, inpatient, and home-based services to over one million New Yorkers annually across the five boroughs. Our extensive health system encompasses ambulatory centers, acute care facilities, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce is dedicated to empowering New Yorkers, without exception, to lead the healthiest lives possible.
At NYC Health + Hospitals, our mission is to provide high-quality healthcare services, without exception. Every team member adopts a patient-centered approach that embodies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathetic communication and collaboration among all individuals.
Job Overview:
Within the Centralized Billing and Follow-up Unit, the Specialty Billing and Follow-up Manager oversees the operational performance of the unit within the Revenue Cycle Services team. This role is accountable for the daily management of the unit's activities, including reviewing accounts, rectifying claim discrepancies, preparing and submitting claims to payers, and updating patient accounting systems.
Reporting to the Director of Centralized Billing, the manager is responsible for the Specialty Unit's performance. Duties include assigning work queues, directing tasks, researching and addressing claim escalations, and guiding the unit in daily production efforts.
Key Responsibilities:
- Provide comprehensive supervision to the Specialty Unit staff.
- Ensure the quality and timeliness of responses to payers and contracted vendors for all assigned claim types.
- Effectively manage a billing and follow-up team responsible for multiple specialty claim types across all hospitals.
- Identify denial trends from payers and their vendors to proactively resolve issues across the system.
- Document and monitor the progress of appeals, providing detailed updates on case statuses.
- Stay informed on guidelines specific to Outlier workflow from CMS and eMedNY.
- Lead unit meetings, workgroups, and provide feedback on operational processes.
- Prepare and review productivity reports for the unit.
- Lead special projects aimed at revenue enhancement for billing and follow-up.
- Ensure timely follow-up with payers on unresolved matters.
- Utilize work queue monitoring and dashboard tools to guarantee efficient processing of claims, prioritizing high-value claims.
- Interpret and apply H+H, city, state, and federal regulations to claims appropriately.
- Identify patterns and processes affecting specialty claims reimbursement and escalate as necessary.
- Supervise the unit, approve leave requests, ensure adequate staffing, and manage vacancies.
- Conduct annual and periodic performance evaluations of team members, establishing standards and priorities.
- Perform additional duties as assigned by the Director.
Minimum Qualifications:
- A Bachelor's degree from an accredited institution in accounting, finance, business administration, or a related field; and,
- Four (4) years of experience in accounting, finance, or business administration, with at least two (2) years in a managerial role within a hospital, medical center, or healthcare facility; and,
- Two (2) years of experience in managing patient accounts or credits; or,
- A satisfactory equivalent combination of experience, education, and training.
NYC Health and Hospitals provides a competitive benefits package that includes:
- Comprehensive health benefits for employees working 20+ hours per week.
- Retirement savings and pension plans.
- Loan forgiveness programs for eligible employees.
- Paid holidays and vacation in accordance with collectively bargained contracts.
- College tuition discounts and professional development opportunities.
- Various employee discount programs.
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