Revenue Cycle Manager – Physician Billing

ChristianaCare•Palacky, KS

22h•Onsite

About The Position

This position involves overseeing the daily activities of the Physician Billing operation at ChristianaCare, one of the Top 100 Hospitals in the nation. The manager will utilize knowledge of revenue cycle principles to ensure accurate and compliant billing. ChristianaCare is a large healthcare provider in the Mid-Atlantic Region, recognized as one of “America's Best Hospitals” by U.S. News & World Report, with ANCC Magnet Recognition® for its hospitals and services. The role is critical in delivering health services guided by values of Love and Excellence.

Requirements

Bachelor’s Degree in Health Care Administration, Accounting, or Business. Relevant experience may be considered in lieu of a 4-year degree.
Five years of physician/medical collections experience with at least three years in a progressive management role.
Must have extensive 1500/837p billing experience.
Must have proven experience with HMO, PPO, and governmental insurance plans’ payer rules and contractual language.

Nice To Haves

Certified Professional Coder (CPC) preferred
Soarian Financials/Millennium experience preferred

Responsibilities

Provides overall management and direction of daily duties related to pre-bill editing, claims management, AR follow-up, denial management, employee education, training, and compliance controls.
Reviews detailed monthly dashboard reports for each entity, including AR balances, denial trends and key performance indicators and takes appropriate action to ensure department/organizational goals are being met.
Works collaboratively with other billing managers, CCHS department managers, executive leadership, and outside agencies regarding identification of issues along with resolution to ensure timely, accurate billing and reimbursement.
Monitors caregiver productivity and performance. Provides feedback and takes appropriate action when necessary.
Files appeals as needed with third party payers and other external agencies.
Recognizes and resolves issues pertaining to contracts and improper billing procedures.
Builds and maintains a close relationship with payer provider representatives to ensure proper claim processing.
Maintains comprehensive knowledge of regulatory requirements related to third party billing rules.
Responds to inquiries with regards to CMS policies, third party payer guidelines, and billing department protocols and advises physician practice staff accordingly.
Reviews communications received from third party payers and shares information with impacted personnel.
Prepares and revises policies and procedures as warranted and conducts in-service/meetings with caregivers.
Safeguards the integrity of billed accounts by ensuring compliance with billing, documentation, and coding standards.