Manager, Professional Billing Operations

Found in: Talent US C2 - 2 weeks ago

Jacksonville, United States Memorial Hermann Medical Group Full time

Description

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. Advanced proficiency in Microsoft Excel and other Microsoft Business applications (i.e. Word, PowerPoint). 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, educational opportunities, interdepartmental activities, and QI activities. Complies with HIPAA and all relevant laws, rules regulations and accreditation standards and requirements. Adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity, and quality of service. Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service. Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff. Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards of providing safe, caring, personalized and efficient experiences to patients and our workforce. Other duties as assigned.

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