Sr Dir, Revenue Cycle HB & PB

Erlanger Health System•Chattanooga, TN

About The Position

Working under the supervision of the VP, Revenue Cycle, the Senior Director Revenue Cycle Hospital Billing and Provider Billing (HB & PB) oversees the acute billing, provider based billing and insurance follow up and the Customer Service Call Center teams. Additionally, has ownership responsibility for the maintenance of the Insurance Master for the health system. Responsible for the accurate and timely billing and follow up of facility AR as well as specialty billing to include Intercompany, Corporate, Client, Bankruptcies, Legal, etc.; The customer service call center receives patient questions regarding bills received, the volume of calls received are often a direct reflection of the quality of work performed by the team members under this director's leadership. The complexity of the provider-based build requires strong time management, organizational, and project management skills. Must have strong knowledge of payer requirements for both professional and acute contracts; inasmuch, maintain the rules and components of systems that ensures contractual obligations are met timely and updated accordingly. Works closely with the payer relation department for build of new payer contracts, creates the standard code for applications for billing and communicates to all applications new insurance master developments and changes. Updates the vendor for Real Time Eligibility, by completing mapping of insurance plans to meet needs of both professional and hospital billing. Enforce regulatory requirements from CMS to maintain billing adherence, as well as a liaison for system build for new provider based departments and changes. Strong knowledge of professional and hospital coding to be the liaison between both the coding and compliance department and HIMs. Understand the centralized process of scheduling and referrals to maintain the workflow for receiving timely authorizations that tie to both professional and hospital billing to maintain timely reimbursement. Responsibilities include managing systems, systems integrity, department operations, processes, staffing, and the financial results of the department. Accounting functions include preparation of monthly journal entries, deferred revenue calculation, bad debt entries, etc. Must be able to professionally and effectively represent the Revenue Cycle department with other Erlanger Departments. Responsible for leading day-to-day operations of department; participates in the development and delivery of staff education, training and orientation. Sets the example for the department as the expert in accurate, thorough and effective work processes. Manages department workload, special projects; identifies issues and develops action plans to correct; reports trends to appropriate departments. Monitors staff productivity that indicates timeliness and accuracy of tasks. Must demonstrate strong problem solving skills, high attention to detail and an aptitude for learning. Must be highly adaptable to understand both applications of professional and acute billing. Ensures departmental adherence to policies and procedures, provides on going analysis of departmental practices and results, recommends, develops and implements process improvements as indicated. Responsible for staff schedules, individual performance evaluations, employee issues and administers disciplinary action when necessary. This manager will serve as a leader and role model for the department by displaying a positive, patient centered, and solution oriented approach and attitude. Performs other duties as required.

Requirements

Bachelors Degree in Accounting or Business Administration
Ten years of progressive experience in healthcare industry with emphasis in billing, collections, managed care processes and compliance.
Must demonstrate strong problem solving skills, high attention to detail and an aptitude for learning.
Must be highly adaptable to understand both applications of professional and acute billing.

Responsibilities

Must understand and demonstrate the importance of providing day to day coaching and mentoring of team members. Developing team members to learn and continue to grow professionally is one of the most important responsibilities of a proven leader.
Holds regular, at a minimum monthly, meetings with team members to review individual and department metrics, goals and identify any training needs.
Works with team members to set them up for success by providing thorough training, appropriate tools, individual guidance and clear understanding of expectations.
Manages daily work of the HB and PB billing team, provider-based billing / insurance follow up team and the customer service team
Monitors team member productivity and quality of work by measures provided in application(s) tools
Ensures training is provided to all team members to actively work and engage in applications, hospital and professional billing; this encompasses claim edits, denials, follow up, rejections and charge capture
Provides day to day coaching and mentoring of team members. Reviews and improves performance by utilizing approaches best defined for team members.
Monitors charges, claim run acceptance, and candidate for billing for all specialty practices
Reports trends in charge lag to respective areas and works to improve metrics
Identifies regulatory changes in CMS requirements for provider-based billing and directs actions as appropriate to both applications, hospital and professional billing
Completes the daily claim run within application(s) to ensure claims are mailed to the respective insurance parties to receive timely reimbursement
Reviews all charges that have administration fees and drug codes to ensure integrity of unit(s) given, and wastage accounted for; this also includes maintaining the National Drug Code (NDC) tables for all specialty practices and their vendors for claim submission purposes (regulatory/compliance)
Completes daily external edits from vendor application(s), hospital and professional billing; investigates trends to enhance build for the claims applications to prevent manual manipulation while improving claim accuracy
Reviews the daily charge router fails, due to missing hospital accounts, missing place of service, and missing EAP codes. Completes registrations as needed to complete charge sessions, update place of service and practice information, review and link charge master descriptions for professional and hospital billing.
Reviews/Resubmits reposted charges created from addendums signed by physicians after the billing hold has released claims to prevent duplicates and ensures compliance of the level of service provided
Preforms daily denial management by working rejections from the clearinghouse (professional and hospital) based upon initial payer responses; updates visit filing order, completes retro review to repost charges, and resubmit claims.
Prohibits timely filing lapses by maintaining and reviewing pending charges from the professional billing application which drives the hospital claims to file for service(s) rendered
Completes inquiries from patient access (RMG) to bypass warnings and edits associated with visit filing order updates for provider-based billing visits
Completes all registration edits from the RMG specialty group for provider-based billing
Completes balance review required for provider-based billing inquires received from RMG specialty practices and customer service representative(s); updates coding, charges, and provides service recovery as needed. Provides patient navigation as needed in regard to statements, visits, estimates, and charges.
Reviews all potential bad debt for self-pay patients receiving provider-based billing services, updates FPL, coverage and takes action on accounts.
Reviews returned mail for provider-based billing, updates guarantor addresses and ensures accuracy associated with statements
Completes and processes all late charges associated with the hospital (acute) application of provider-based billing while adhering to the policy.
Monitors credits associated to the contractual agreements set forth by the provider-based billing contracts with payers. Updates charges to take adjustments, remove adjustments and balancing of accounts to ensure error proof statements to patients.
Analyzes follow up and denials metrics, trending and reporting to substantiate positive and compliant net revenue impact to both the Professional and Technical services
Completes specialty billing for institutional and corporate guarantors for hospital and professional service(s)
Maintains/Completes daily adjustment requests from team members requesting accounts be corrected for contractual adjustments, denials, par/non-par, etc. for both professional and hospital billing
Updates and maintains the insurance master for Erlanger Health application(s), develops naming conventions, electronic billing submission, and workflows surrounding payers/plans. Communicates/Educates on developments quarterly or annually as needed
Completes mapping of insurance plans that are Real Time Eligible (RTE) enabled to master payer levels
Ensures compliance based on payer contracts and billing for provider-based specialties
Coordinates/Tests build for provider additions, new departments, department/organizational moves while maintaining compliance with CMS guidelines
Updates accounts from internal audit/coding and compliance for inaccuracies related to global billing
Monitors customer service center call volumes, abandonment rates, reasons for calls to consistently identify areas of concern with upstream processes creating the need for these calls.