Commercial Managed Care Collections and Denials Manager - HB Patient Financial Services - FT Days

University of California, Irvine•Anaheim, CA

61d•Onsite

About The Position

The Commercial/Managed Care Collections/Denials Manager reports to the Assistant Director-Patient Financial Services and is responsible for managing hospital accounts receivables (A/R) and the collections, denial, and workflow activities for Commercial/Managed Care payers – Commercial, Managed Care, Workers Compensation, TriWest/VA and all other third-party payers. The incumbent manages daily operations certifying timely accurate account evaluation, escalation, and resolution ensuring compliance with procedures, standards, and policies as well as regulatory requirements. This role is responsible for training, managing work performance, A/R analysis, resolution of operational and personnel issues, evaluations, hiring, and corrective actions as needed. Presents as a key liaison between PFS and various departments leaders within the organization to identify and resolve issues relating to charges, coding, appropriate modifiers, and claim adjudication to yield first pass clean billing and enhanced revenue recoveries. Also responsible for performing routine analysis of various key performance indicators, dashboards, and reports to optimize performance and maintain positive A/R disposition.

Requirements

Thorough knowledge of medical and insurance terminology, and of billing and / or collections internal procedures and external regulations.
Strong time management and organization skills
Strong technical knowledge of CPT, HCPS and ICD-10 coding, LCD, NCD, MUE, CCI, Modifiers, authorization requirements and related documentation
Strong interpersonal and communication skills to collaborate and effectively manage conflict with all constituent groups
Strong analytical and report writing skills to effectively comprehend multiple reports and analyze array into actionable form
Strong ability to facilitate accurate and timely billing and collections
Solid, demonstrated leadership skills to coach, mentor, and strengthen the team’s performance
Solid knowledge of human resources management policies, with the ability to evaluate and document human resources matters and performance.
Solid critical thinking and decision-making skills, with the ability to analyze and evaluate complex and/or difficult problems, determine appropriate level of intervention, and develop and apply viable solutions
Proficient in Microsoft Office and related programs (i.e. Microsoft, Excel, Outlook, PowerPoint, etc.)
Must possess the skill, knowledge and ability essential to the successful performance of assigned duties
Must have the ability to maintain a pace appropriate to the workload
Minimum of three (3) years of experience in billing and collections of Commercial, Managed Care, Medicare, Medicare Advantage, Medi-Cal, CalOptima, FQHC, and CCS and other programs that fall under the scope of Government programs and commercial billing
Minimum of five (5) years of related relevant experience in business office operations, consulting, or auditing
Excellent verbal and written English communication skills including the ability to convey complex information in a clear, concise manner
Demonstrated lead/supervisory skills to effectively oversee and prioritize staff activities and manage complex workflow and multiple priorities associated with billing and/or collections operations
Demonstrated ability to use sound judgment
Bachelor's Degree in related area and/or equivalent education/experience
Ability to function independently and as a member of a team
Must be able to provide proof of work authorization

Nice To Haves

Prior experience with and working knowledge of EPIC electronic health record

Responsibilities

Managing hospital accounts receivables (A/R) and the collections, denial, and workflow activities for Commercial/Managed Care payers – Commercial, Managed Care, Workers Compensation, TriWest/VA and all other third-party payers.
Managing daily operations certifying timely accurate account evaluation, escalation, and resolution ensuring compliance with procedures, standards, and policies as well as regulatory requirements.
Training, managing work performance, A/R analysis, resolution of operational and personnel issues, evaluations, hiring, and corrective actions as needed.
Serving as a key liaison between PFS and various departments leaders within the organization to identify and resolve issues relating to charges, coding, appropriate modifiers, and claim adjudication to yield first pass clean billing and enhanced revenue recoveries.
Performing routine analysis of various key performance indicators, dashboards, and reports to optimize performance and maintain positive A/R disposition.