Manager of Accounts Receivable and Coding

East Carolina University • Greenville, SC

35d • $55,000 - $62,000

About The Position

This position is within the Office of Business Operations and Financial Affairs (B&F) at the ECU School of Dental Medicine (SoDM). This position reports to the Director of Revenue Cycle and serves as the Manager, Accounts Receivable and Coding. This position is responsible for the core accounts receivable (AR) functions including account resolution and collection of claims (~$16 million annually), workflows for B&F staff to optimize collections, determination of appeals of denied claims; and division of responsibilities between B&F and CSLC staff as it relates to account collection and resolution. The position also oversees all aspects of coding and its integration with: account collection, in collaboration with the Manager, Cash Management and Claims the interface of coding related to pre-submitted claims, and the overall communication and education/training of coding with Faculty and Students, including annual changes in codes and/or their interpretation. The Manager of Accounts Receivable and Coding also is responsible for the composition and administration of the SoDM's prospective audit, communications with Faculty to discuss claims which require changes, education of both Faculty and students on aspects of coding their services and specific coding interpretations. Also, interfacing with and alignment with the Office of Institutional Integrity (OII) on any external coding audits or inquiries. The clinical enterprise is composed of six clinical operations within Ross Hall (Student Clinic, Student Learning Center (SLC), Pediatric/Orthodontic Clinic, Faculty Practice Clinic (FP), Advanced Education in General Dentistry (AEGD) and the Clinical Research Center); the General Practice Residency Clinic (GPR); as well as eight Community Service-Learning Centers (CSLCs) located across the State of North Carolina.

Requirements

• Bachelor's degree in business administration, public administration, or related business area; or equivalent combination of training and experience.
• All degrees must be received from appropriately accredited institutions.
• Applicants must be currently authorized to work in the United Sates on a full-time basis.

Nice To Haves

• Previous experience in healthcare setting working with patient billing
• strong verbal and written communication skills
• strong analytical skills

Responsibilities

• The Manager, Accounts Receivable and Coding manages the business functions of outstanding receivable accounts for both insurance and patients, interpreting insurance company billing policies, implementing internal policies to determine; which claims are considered resolved, under what auspices denied claims will be considered unresolved and appealed, and which amounts unpaid by insurance will be transferred to patients.
• This position must translate broad policies and procedures from State and Federal Governments and University Departments to develop and maintain sustainable operating procedures.
• The Manager, Accounts Receivable and Coding is responsible for primary reporting and compliance components of these elements of SoDM's Revenue Cycle. This includes, but is not limited to, established organizational and industry metrics such as days in AR, AR aging, percentages of denials, net collections, and overall collections.
• The position develops and analyzes financial data for patterns to help find accounts which might otherwise go undetected for lack of or incorrect payment in order to improve SoDM revenue collection; and must have current knowledge of billing regulations, clinical coverage policies and insurance industry changes, in particular any/all changes related to coding as the organization's subject matter expert on coding.
• This position is also responsible for the coding operations and monitors all processes, procedures and business activities as it relates to the operation of the prospective audit, working with and under supervision of the Director.
• Also determines, in collaboration with the Director, the composition of the audit, including which codes, which clinics or providers, and what percentage of a provider's or code's claims are included in the audit in order to optimize the impact on compliance with industry standards for documentation, dental record accuracy and appropriate reimbursement.
• The position supervises two FT Advanced Accounting Technicians - Remittance, one University Program Associate, and 1.75 FTE Coders.
• The position provides leadership, administrative direction and training in the development of processes, policies and systems that contribute to successful business operations.
• The position applies techniques, practices and procedures and robust continuous improvement efforts in both dental/clinical operations and financial operations to optimize performance in a rapidly changing regulatory and operational environment.
• Promotes employee engagement, motivation, retention and optimal performance in a cooperative, goal-oriented culture.
• The position develops policies and procedures to insure appropriate internal controls of all clinical billing reconciliation and appropriate designation of expenditures to meet generally accepted accounting principles and the application to cost, governmental accounting, and non-governmental accounting.
• Maintains job descriptions that reflect the current work responsibilities of staff.
• This position requires an in-depth knowledge of current dental and medical insurance payor guidelines and regulations, as well as dental business office operations.
• Incumbent should understand and be able to optimize processes for account collection and reconciliation, ongoing high-volume coding audits, communication and training for B&F staff to prevent future denials and for faculty and students to improve coding accuracy.
• It is imperative that the role works with faculty, students, other Managers and staff in a professional and highly collaborative manner.
• Working with the support of the Director and Manager of Cash Management and Claims in Business and Finance, apply monitoring tools and meet established metrics for performance standards under position's control.
• Such standards include but are not limited to; timely appeals of claims, timely response to B&F staff inquiries, coordination of post-submission revenue cycle processes with pre-submission processes.
• Supporting the Director, and working with the Manager of Cash Management and Claims, work to meet overall departmental and organizational standards such as, but not limited to; Days in AR, AR aging, percentage of dentals, net collections and overall collections.
• Role requires a super-user level of expertise with the axiUm system, the School's Dental Management Software System, as well as competence in university systems such as Business Intelligence, to link technology to process to people most efficaciously in accomplishing all of the above.
• Work effectively in a team environment, with other B&F management staff, Clinical Affairs and CSLC management and their staff, with other internal University Departments (e.g. Office of Institutional Integrity (OII), Internal Audit) and external stakeholders such as insurance companies (e.g. Delta Dental, United Healthcare, etc.) and private and public (e.g.North Carolina Department of Revenue) entities.
• This position independently resolves, collaborates with peers, and makes recommendations to resolve complex issues and problems, and serves as a trainer and resource to SoDM.
• This position provides support and training for all post-claims submission revenue cycle related issues both for all SoDM clinics at Ross Hall as well as at remote operations including Community Service Learning Centers (CSLCs) and GPR.
• Role requires a focus on best practices in terms of processes and operations, as well as working towards standardization of practice across all SoDM clinics and continuous improvement.
• This position oversees all customer service elements of the revenue cycle, insuring staff provide accurate, professional and customer-centric service to internal stakeholders or patients with questions or issues with their SoDM accounts.
• In support of the Director and B&F, conduct analyses, document findings, prepare presentations, provide recommendations and execute agreed upon plans.
• Keep current knowledge of the payor, regulatory issues and active in applying operational changes necessary to optimize functions in this changing environment.
• This position anticipates problems and develops recommendations for management resolution.

Benefits

• Employment in this position provides eligibility to participate in the UNC Optional Retirement Program (ORP) which offers matching employer contributions and employee control of investment choices, along with eligibility to participate in various Voluntary Supplemental Retirement Plans (401k, 403b. 457).
• This position is not eligible to participate in the NC Teachers' and State Employees' Retirement System (TSERS).
• Additionally, this position offers multiple voluntary options for Medical, Dental, Vision, and Life Insurance as well as various supplemental plans including Critical Illness, Flexible Spending Accounts, Cancer, and Disability.
• While this position is not automatically eligible for the NC Teachers' and State Employees' Retirement System (TSERS), new hires transferring from another North Carolina state agency and current ECU employees transferring internally who had been enrolled in TSERS in their previous employment will continue participation in TSERS.
• These individuals may be able to elect to participate in ORP if they had not been offered that option at the time of their initial enrollment into TSERS.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Industry: Educational Services
• Number of Employees: 5,001-10,000 employees