Manager, Patient Financial Services and Professional Billing

Overview

We are looking for a Manager, Patient Financial Services and Professional Billing to join our collaborative team at Memorial Health!

• Responsible for overseeing initiatives to improve net revenues, reducing receivables and improve compliance in support of organization goals
• Ensures billing practices are consistent with internal policies and external requirements of payors
• Identifies and analyzes revenue cycle trends and make appropriate recommendations to leadership
• Monitors/identifies/implements improvements in Professional Billing and Patient Financial Services, working in concert with manager of Registration and Central Scheduling Departments
• Maintains current working knowledge of federal and state regulations regarding the revenue cycle
• Oversees projects related to revenue opportunities, management of charge master maintenance, pricing strategy, cash collections and patient estimates
• Provides status of organization’s billing/claims collection performance to leadership
• Informs leadership of any significant issues (i.e. bills in discharged, not billed (DNB) status, cash posting backlogs, cash delays, etc.) and monitor progress to resolution

• Strategic leadership for the following departments/functions:
  Patient Financial Services, Professional Billing, Charge Description Master (CDM) Coordinator, Hospital Contract Modeling, and Inpatient & Observation Notification
• Monitors team performance to ensure timeliness, accuracy, and compliance standards are being achieved
• Facilitates timely and complete resolution of all customer questions and concerns
• Motivates employees to accomplish department goals in support of the Hospital’s strategic plan
• Monitors staffing productivity measures and ensure employee accountability
• Provides mentoring, training and development for management team and staff
• Monitors expenses to ensure within approved budget
• Participates in staffing interviews, employee selection, performance evaluations, and disciplinary actions
• Ensures adequate controls are in place for all reporting departments, e.g. develop and maintain policies, procedures, and guidelines

• Provides subject matter expertise to ensure data validity and accuracy in payer reimbursement models
• Develops and fosters strong payer relationships
• Maintains a comprehensive knowledge and understanding of all Hospital payer contracts, terms and reimbursement
• Maintains a comprehensive knowledge of medical policy as it applies to each payer
• Collaborates with payers to resolve claim issues (authorization denials, claim rejections, claim denials, etc.) in a timely manner
• Maintains knowledge of contract provisions in other third-party managed care contracts

• Compiles data and provides key performance indicators to Director
• Compile and prepare data, reports and analyses for various Hospital departments and directors
• Prepare and send Credit Balance report to CMS quarterly. Oversight and assist with data collection for Hospital Care Assurance Program (HCAP), Hospital Charity Care (CC), Medicare and Medicaid Cost Reports, Bad Debt report and annual payer Credit Balance Reviews
• Analyze reports and outcomes as they pertain to revenue cycle management; including monitoring of accounts receivable (A/R), claim denials and appeals, late charges, key performance indicators, ICD-10 financial monitoring, scheduling/call statistics, authorizations and registration quality. Report to leadership as appropriate
• Creates ad hoc billing information and reports to facilitate decision making processes
• Provides scheduled standard reports to leadership

• Ensures systems dictionary files, data elements, interface and mappings are maintained
• Facilitates successful system implementations, conversions, and upgrades for revenue cycle applications
• Assesses new technology, performs vendor assessments, and creates ROI analyses and recommendations for leadership
• Maintains oversight of staff access for all payer websites

• Ensures adherence to regulatory and compliance
• Ensure file…