Manager, System Patient Accounting

1 month ago

Warwick, United States Good Samaritan Hospital Full time

Job Details:

Manager, Supply Chain Automation is responsible for overseeing the billing, follow-up and denials management function at Bon Secours Charity Health System. This position is responsible for the billing process including scrubbing, correcting and processing all payer claims based on claim processing rules within established timelines for reimbursement. The Manager, Central Business Office will also oversee the follow-up process by reviewing payer payment status for all governmental and third party claims that have not generated a payment or denial within an appropriate amount of time. Additionally, this position manages the denial management process and monitors denial write offs optimizing net revenue recognition and recovery.

RESPONSIBILITIES:

Oversees the day-to-day to day direction of all units with the Supply Chain Manager, and represents the Manager in interdepartmental and revenue cycle meetings in the absence of the System Director. Manages communication with clinical departments, on-site staff, Patient Access and Coding, reduce or eliminate billing and recurring denials that could potentially be avoided, and establish appropriate prevention measures.  Manages the team's ability to maximize collection dollars from payers in accordance with the respective contract and hospital financial arrangements.  Ensures that all activities related to denials management functions meet department requirements, maximizes revenue collection, and achieves leading practice levels of performance.  Implements strategies that will minimize denials to ensure proper reimbursement for services provided by the organization, which includes auditing, managing, monitoring and reporting on trends and suggesting education to address specific processes, coding and billing regulations and prevent further claims denials.  Supervises and coordinates the activities associated with billing, follow-up, and denials and appeals.  Works with staff, payer representatives, vendors, and other departments to resolve outstanding billing, follow-up, and denial and appeal issues.  Displays commitment to treating both internal and external constituents as clients and customers, maintains a flexible customer service approach and orientation that emphasizes service satisfaction and quality.  Stays abreast of the latest developments, advancements, and trends in revenue cycle service, billing, follow-up and denials management by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure.  Integrates knowledge gained into current work practices. Oversees the process of billing government payers (Medicare, Medicare HMOs, Medicaid, Medicaid MCOs/HMOs, Tricare, Tricare for Life, Veterans Affairs) as swiftly and efficiently as possible. Oversees the team's ability to maximize collections dollars from all payers in accordance with the respective contract and hospital financial arrangements.  Directs the efforts of the Billing, Follow-up and Denials Management staff in the data collection, analysis, appeal, write-off and reporting activities.  Monitors denial write-offs to ensure staff is using the appropriate write-off codes.  Works with Coding Leaders to determine appropriate changes for DRGs, CPT, ICD px related denials.  Works with Revenue Integrity Leaders for charge related denials.  Works with Corporate Responsibility and Legal for any federal and state mandated audits.  Works with Contract Management for any contract interpretation denials.  Monitors staff productivity and ensures key performance metrics are met on a daily basis.  Monitors and tracks external vendors responsible for billing, follow-up and denial process, and ensures they are following the BSHSI guidelines.  Ensures adequate training is being provided to staff to educate on the following skills: current working knowledge of payer requirements; sufficient healthcare knowledge necessary to perform job requirements; knowledge of state, local and federal policy requirements for functions performed; and relevant knowledge of information technologies.  Performance Monitoring Analyzes denial and underpayment reports, provides feedback on root causes of denials, and formulates denials resolution strategies.  Works with the Follow-up Manager to establish and monitor accounts receivable management and cash collection goals/targets.  Manages comment code inventory to ensure SLA inventory levels are maintained and issues are resolved.  Manages the department dashboard and design action plans as issues are identified within the unit.  Ensures that key performance metrics are met on a daily basis.

QUALIFICATIONS / REQUIREMENTS:

Minimum 5 years experience in patient accounting, in a leadership position in Patient Financial Services with at least 8-10 years of billing, follow up and denial management and related patient financial services experience. Comprehensive knowledge of healthcare management, billing management, follow up and collections management and denials and appeal management ·Significant understanding of payer guideline from claims submission to denial and appeal review and proficient with payer websites and other useful resources pertaining to the billing functions ·Understanding of the impact of claims processing service, insurance follow up services and denials management services has on the revenue cycle operations and financial performance

EDUCATION:

Associate's degree in business, finance, or healthcare administration required, Bachelor's degree preferred; equivalent work experience may substitute degree requirement

OTHER: 

If applicable, the individual performing this job may reasonably anticipate coming into contact with human blood and other potentially infectious materials. Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.

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