Manager Payment Integrity Professional Billing

#REF!•Arlington, TX

17d•Remote

About The Position

Under general direction of the PBO Revenue Integrity Director, the PBO Payment Integrity Manager is responsible for overseeing insurance payment activities to ensure accuracy, proper escalation, and effective resolution. Consistent fiscal performance and achievement of specific departmental standards and goals. The Manager oversees direct staff to ensure stated goals are met through the following processes: vetting reported issues, proactive and reactive reporting to capture impact, payer escalations, attending JOCs (Joint Operating Committee), monthly report outs for executives on progress and outstanding issues. The manager is also responsible for monitoring and improving all revenue cycle metrics and measures, including but not limited to the following: AR days, aged AR, cash collections, denials, avoidable write-offs, staff productivity and work quality. All responsibilities are performed in accordance with established organizational policies, procedures and compliance and quality standards.

Requirements

Associate's Degree Business Administration, Finance or other healthcare related degree Required Or Bachelor's Degree Business Administration, Finance or other healthcare related degree Preferred Or Master's Degree Preferred
8 Years Experience in payment integrity for professional billing for a provider group. Extensive knowledge in reporting and analytics, resolving payer issues, ongoing tracking and trending, attending JOCs(Joint Operating Committee) Required
5 Years Management Experience Required
Possess a strong work ethic and a high level of professionalism.
Demonstrates good understanding of health insurance billing, follow-up, credits, regulations, and payer requirements.
Proficient computer and EMR skills, including but not limited to, Microsoft Office suite applications such as Word and Excel.
Demonstrated business and analytic/financial skills.
Strong communication and organizational skills.
Proven experience in a billing environment.
Strong people management and development skills.
Ability to shape communications to the needs of the audience.
Knowledgeable of HIPAA, state and federal regulations governing confidentiality, release of information and record retention.
Familiar with Electronic Medical Record (EMR) functionality, document imaging, and workflow.
Must be a dependable self-starter and deadline driven.
Must have the ability to work well independently and in a team setting to meet organizational goals.
Must demonstrate solid understanding of key revenue cycle workflows, technical system, and metric goals.

Nice To Haves

Bachelor's Degree Business Administration, Finance or other healthcare related degree Preferred
Master's Degree Preferred
Epic Experience a Plus
Other Dual Hospital and Professional Coding Certification(s) (CPC, CPC-H, CCS, CCSP). Upon Hire Preferred
Epic CareConnect EMR experience and certifications are a plus.

Responsibilities

Responsible for the direction and coordination of all payment integrity operations related to the processing and adjudication of professional claims to insurance.
Manages all essential payment integrity team functions. Effectively leads and develops a team including training.
Ensures all payment integrity team staff are current in competencies, assessments, licensure, certifications, and other annual training.
Ensures work environment complies with regulatory, licensure, compliance, and accreditation requirements by monitoring the work setting on an ongoing basis to identify deficiencies, risk and opportunities for improvement.
Participates in and completes all required employee training, including recurring and ad-hoc education sessions.
Enforces and monitors corrective action plans.
Manages payment integrity operations to resolve claim, denial, payment issues with the payors and implements risk mitigation and resolution strategies.
Implements and manages performance goals and objectives as well as long-term performance planning.
Reports all confirmed or suspected privacy breaches, concerns regarding privacy to the Entity Safety Office or Compliance in a timely manner.
Assists with training, auditing of work, and provides feedback to team on opportunities for improvement. Ensures productivity goals, metric benchmarks, and quality standards are consistently met by all team members.
Regularly reports out to PBO Revenue Integrity Director and other entities as necessary regarding department metric performance, risk, achievements, and resolution strategies.
Demonstrates strong technical skills to review and evaluate trending metric data for root-cause analysis.
Regularly monitors appropriate metric dashboards and addresses technical issues and user education opportunities, as appropriate.
Serves as first point of contact for complaints related to payment integrity team operational concerns and feedback.
Responsible for investigating all complaints related to payment integrity team operations and routes privacy and/or compliance complaints/issues. Escalates problems as needed.
Attends and engages in all applicable meetings, committees, and work groups to communicate payment integrity updates and resolve process issues. Acts as a liaison between the payment integrity team and key department stakeholders including Operations, Coding and Reimbursement, Patient Access, PB AR, vendors and executive leadership.
Helps resolve more complex and/or escalated payor issues, handling follow-up questions and resolving payor discrepancies or errors in collaboration with staff.
Conduct follow-up on identified discrepancy and root-cause analysis to prevent systematic recurrence of quality issues.
Interprets and/or evaluates information and/or creates analytical approaches.
Analyzes on a macro and micro scale to identify problematic activity impacting AR aging, denials, and write-offs for departments and providers.
Initiates revenue acceleration projects and special projects as a result of ongoing analysis.
Consistently organizes, evaluates, and executes on strategies to improve department performance metrics through all available reporting resources.
Develops new ideas resulting in major improvements to existing methods, services, processes and/or procedures.
Seeks new and creative technologies that help identify and guide improvement opportunities that align with overall PBO success.