Specialty Billing Operations Manager

2 weeks ago

New York, New York, United States NYC Health + Hospitals Full time

About NYC Health + Hospitals:

Empowering Every New Yorker 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, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce is dedicated to empowering New Yorkers to lead the healthiest lives possible.

At NYC Health + Hospitals, we are committed to providing high-quality healthcare services. Every team member embodies a person-centered approach that reflects our ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathetic communication and collaboration.

Position Overview:

The Manager of Specialty Billing and Follow-Up is tasked with overseeing the Specialty Billing and Follow-Up unit within the Revenue Cycle Services team. This role is crucial for ensuring the daily operational efficiency of the unit, which includes 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 will be responsible for the performance of the Specialty Unit. Key responsibilities include:

  • Supervising the Specialty Unit staff
  • Ensuring quality and timely responses to payers and contracted vendors for all assigned claim types
  • Effectively managing a billing and follow-up team responsible for multiple specialty claim types across all hospitals
  • Identifying denial trends from payors and their vendors to proactively address issues
  • Documenting and tracking the progress of appeals, providing detailed updates on case statuses
  • Staying informed on CMS and eMedNY guidelines specific to Outlier workflow
  • Leading unit meetings and workgroups, offering feedback on processes
  • Preparing and reviewing productivity reports for the unit
  • Leading special projects aimed at revenue enhancement
  • Ensuring timely follow-up with payers on unresolved matters
  • Utilizing monitoring tools to ensure efficient processing of claims
  • Interpreting and applying relevant rules and regulations to claims
  • Identifying patterns affecting specialty claims and escalating issues as necessary
  • Providing overall supervision, approving leave requests, and ensuring adequate staffing
  • Conducting performance evaluations and setting team standards
  • Performing additional duties as assigned by the Director

Minimum Qualifications:

  1. A Bachelor's degree from an accredited institution in accounting, finance, business administration, or a related field; and,
  2. Four (4) years of experience in accounting, finance, or business administration, with at least two (2) years in a managerial role within a healthcare setting; and,
  3. Two (2) years of experience in managing patient accounts or credits; or,
  4. A satisfactory equivalent combination of experience, education, and training.

NYC Health and Hospitals offers a comprehensive benefits package that includes:

  • 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 collective bargaining agreements
  • Tuition discounts and professional development opportunities
  • Various employee discount programs

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