Revenue Cycle Manager (Referrals)

Columbia University In the City of New York•New York, NY

68d•Remote

About The Position

The Revenue Cycle Manager (Referrals) provides strategic oversight of a central revenue unit that manages the process of obtaining referral/authorization for scheduled and unscheduled services as required by payer policy. The Manager is responsible for monitoring unit performance, work quality, efficiency, and compliance with policies and regulations.

Requirements

Requires bachelor's degree or equivalent in education and experience.
Minimum of 4 years' related experience in a physician billing or third-party payor environment.
An equivalent combination of education and experience may be considered.
Demonstrated intermediate skills in problem assessment, resolution, and collaborative problem solving in complex and interdisciplinary settings, including strong proficiency in healthcare and payer guidelines as it pertains to referrals.
Ability to work collaboratively with a culturally diverse staff and patient/family population, strong customer service skills, demonstrating tact and sensitivity in stressful situations.
Ability to work independently and follow through, and handle multiple tasks simultaneously.
Excellent verbal and written communication skills.
Intermediate to advanced level proficiency of Microsoft Office (Word & Excel) or similar software is required, and an ability and willingness to learn new systems and programs.
Must be a motivated individual with a positive and exceptional work ethic.
Must successfully complete systems training requirements.
Demonstrated intermediate proficiency in the health insurance referral process as it pertains to insurance and managed care reimbursement concepts and overall operational impact.
Must successfully pass systems training requirements.

Nice To Haves

At least 2 years of direct supervisory experience is preferred.
Knowledge of Epic
Knowledge of Epic and GE/IDX billing systems is preferred.

Responsibilities

Manage daily operations of the referral unit. Monitor and manage operational workflows and work queues, and programs on a regular basis for efficient use of resources. Evaluates the need for new tasks or functions to support the proper processing of referrals to secure reimbursement by payers.
Ensure adherence to the priority matrix for work to avoid unnecessary delays. Monitor work queue inventory to ensure that accounts are worked timely manner. Advise leadership of potential backlog and advise on remediation, leveraging optimization opportunities and technological tools.
Ensures policies and procedures are kept up to date and are communicated, ensures that information is understood and adhered to by supervisors and staff.
Lead to manage special projects and/or higher complexity issues escalated by Referral Specialists for resolution.
Make recommendations and execute quality and audit control measures to achieve compliance and optimum efficiency in alignment with Columbia policies, regulatory guidelines, and industry best practices.
Serves as the subject matter expert responsible for troubleshooting, analyzing, and performing resolution management for referrals.
Evaluate work queues to verify WQs are capturing the appropriate activities and analyzing inflow for issues & trends. Analyzes patient WQ's to find trend issues and works with appropriate management and departments, such as IT, to bring issues to resolution.
Reviews, analyzes, and communicates payer industry standards, policies, and other changes to supervisors, staff, and departments. Stays apprised of payer process changes. Stays apprised of batch and electronic insurance eligibility and other insurance coverage tools for improved automation.
Performs analysis, provides feedback, and prepares reports on insurance verification activities/operation (e.g,. operational efficiencies) to Directors.
Responsible for maintaining and developing workflows and assisting in backlog reduction.
Reviews denial reports for trends and researches denials related to referrals. Identifies root cause and prepares issues for escalation.
Collaborates closely with other revenue cycle functions and clinical departments to establish effective communications to further the efficiency of the revenue cycle process.
Aligns referral operations to overarching centralized revenue cycle goals and key performance indicators.
Gathers and assesses data to identify trends and gaps across Revenue Cycle processes. Uses analysis to make recommendations for improvements and optimization. Participates in improvement/optimization initiatives.
Develops and maintains a good working relationship with all practice managers, departmental management, and the NYP Financial Clearance Center department. Promotes a customer service orientation in interactions with patients, physicians, department staff, and external organizations through personal example.
Provides oversight of unit supervisor(s) and staff, including recruiting and human resource management. Manages and mentors supervisors to onboard and train referral staff. Provides guidance and direction to supervisors on managing staff.
Promotes a culture of collaboration, facilitating continuous process improvement and professional development.
Oversee team performance, ensuring productivity and quality benchmarks are consistently achieved.
Evaluates staff performance and takes corrective action in accordance with departmental HR guidelines. Review staff productivity and quality measures. Administer improvement plans as required.
Lead regular team meetings to discuss updates, address challenges, and reinforce best practices.
Participates in committees, task forces, and workgroups regarding all applicable referral compliance and other pertinent regulations.
As a member of the Authorizations management team, performs other tasks, assumes additional management or supervisory responsibilities within the Revenue Cycle Department as assigned.
Represents the FPO on committees, task forces, and work groups as assigned.
Conforms to all applicable HIPAA, Billing Compliance and safety policies and guidelines.
Other duties as assigned