Manager, Payor Relations & Customer Exp

PROMETHEUS LABORATORIES INC•San Diego, CA

About The Position

The Manager, Payor Relations and Customer Experience (PRCE) will be responsible for monitoring, motivating, training associates in the Triage Order Quality (TOQ), Customer Experience (CEx), and Direct Bill support.

Requirements

Bachelor’s degree in a related field or 6 + years of progressive revenue cycle related leadership experience.
Minimum 4 years’ experience working in laboratory or diagnostic test industry.
Minimum 3 years’ experience overseeing internal or outsourced teams.
Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents.
Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.
Ability to write speeches and articles for publication that conform to prescribed style and format.
Ability to effectively present information to top management, public groups, and/or boards of directors.
Ability to work with mathematical concepts such as probability and statistical inference, and fundamental of plane and solid geometry and trigonometry.
Ability to apply concepts such as fractions, percentages, rations, and proportions to practical situations.
Ability to define problems, collect data, establish facts and draw valid conclusions.
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Responsibilities

Supervision of staff and daily operations of the PRCE billing functions.
Collaborates with the IT department to design, improve and implement effective processes.
Develops operational and volume metrics and analyzes them on a monthly basis. Makes appropriate staffing recommendations based on volume.
Recommends and implements process improvements.
Maintains up-to-date expertise and knowledge of compliance, CPT code changes, healthcare billing laws, rules, regulations, and developments necessary for the organization to make informed business decisions.
Ensures procedural requirements are followed and ethical standards for the follow-up of overdue accounts are maintained.
Communicates immediately to Management regarding any compliance related problems or unresolved processes.
Ensures that employees are trained and compliant with SOP’s and competency checklists.
Oversees personnel management activities for the department; motivating, training, and mentoring staff.
Oversees performance appraisals, documenting deficiencies, developing plans for improvement and counseling employees.
Develops department objectives and performance goals; assists with monitoring work performance to determine staff resources utilization; assists with reviewing monthly work statistics and budget reports; assists with establishing work performance standards and adjusts staffing levels as needed.
Communicates cross-functionally and as appropriate, any changes to PRCE that may impact internal processes, commercial messaging, external customers, or patients.
Ensures that a safe working environment is maintained and that safe work practices are employed; ensures staff participation in all safety, compliance and other mandatory training.
Ensures adherence to all State and Federal guidelines and regulations, including compliance with CLIA and CAP regulations and HIPPA and HITECH.
A developing professional. Working knowledge and application of business and technical concepts, procedures and practices. General knowledge of industry practices, techniques, and standards. General understanding of business unit/group function. Exercises judgment when interpreting company policies and procedures to resolve a variety of issues.
Develops solutions to a variety of problems of moderate scope and complexity where analysis of situations or data requires a review of identifiable factors. Exercises judgment to determine appropriate action. Has knowledge of alternatives and an understanding of their impact on the business or technological environment.
Plans, organizes, and prioritizes own daily work routine to meet established schedule.
Works under general direction regarding the progress of projects and special assignments. May seek guidance in resolving problems, interpretating established policies, procedures and practices. Work is reviewed for soundness of judgment.
Contributes to the completion of departmental projects and goals. Errors in judgment, poor recommendations, or failure to achieve results would normally require a moderate expenditure of resources to rectify.
Engages with internal company contacts. Represents organization on specific projects. Uses diplomacy and tact in interactions and problem solving.