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Description
To be fully engaged in providing Quality / No Harm, Customer Experience, and Stewardship by: proactively maintaining and promoting revenue cycle operations within Heath First Inc./HF Medical Management. Ensures the financial integrity of Heath First Inc./HF Medical Management by performing established back end revenue cycle processes that enable and Epedite the billing and collection. This includes: Customer Service, billing claims according to Federal /State, and Managed care rules, regulations and compliance guidelines,
patient account research and resolution, insurance verification and benefits determination, identification of reimbursement issues, cash posting and reconciliation, resolution of credits and issuance of refunds, identification of payment variance invoices, follow up and resolution of denied claims.
Primary Accountabilities
• Develop and present results to Leadership via presentation on facility and systems wide outcomes of increased net revenue (after contractual adjustments): decline of compliance issues and charge denials by contract payers.
• Provide leadership and training for multidisciplinary staff members to increase facility-wide knowledge in the complex requirements of the varied healthcare billing/reimbursement methods.
• Responsible for achieving accurate and timely billing of all potential charges.
• This position is responsible for planning, staffing, organizing, directing, controlling and continually improving all aspects of billing, collections, revenue cycle analysis and reporting.
• Overseas the day-to-day operations of billing, payment posting, collecting patient account services functions and the maintenance and ongoing improvements in the billing system and other related software applications.
• Develop, implement and maintain charge practices, policies and procedures, including clinical system interfaces affecting charge capture.
• Coordinates with various departmental staff who are responsible for the charging in their departments to implement changes due to regulatory requirements, operating efficiency needs as well as develop programs to educate staff on all necessary changes.
• Develop, implement and manage revenue integrity audits and staff training to insure complete and compliant charge capture.
• Assist in projects as directed by Vice President of Revenue Operations.
• Ensure that patient account services maintain effective communication methods resulting in high satisfaction levels with patients, other departments, and within Revenue Operations.
• Participate on various committees designed to improve operational processes and satisfaction.
• The position is also responsible for analyzing payer contracts, monitoring financial performance of contracts, analyzing revenue cycle related data and reporting on trends and variances.
• Develop, implement and manage revenue variance analysis, including volume and pricing variances for Gross and Net Revenue for service line, departmental and payer levels such that revenue capture is increased.
• Assists V.P. Revenue Operations to accomplish budget.
Qualifications
• Bachelor’s Degree in Business or related field or minimum of seven years experience in a large health care organization in relevant management level positions required. Master’s Degree in Business Administration or Healthcare Administration preferred.
• Extensive knowledge in the areas of patient registration, billing, accounts receivable (AR) and cash management requirements, managed care contractual terms and requirements, health insurance practices, industry regulatory requirements, business office operations, financial reporting technology, wage and hour regulations, basic accounting, and industry standards for healthcare revenue resolution management practices.
• Ability to analyze and resolve problems that affect the account resolution process, regardless of whether the problem originates in an area under direct or indirect control.
• Financial management skills, including the ability to financially analyze data for operations, budgeting, auditing, forecasting; basic accounting knowledge, market analysis; staffing and financial reporting skills.
• Leadership skills to motivate cross-departmental team performance towards excellence and develop team concepts and consensus-building management styles.
• Knowledge of CPT codes and ICD-9 codes as well as all government and other payer billing and collections rules and regulations required.
• Ability to analyze trends, develop and maintain performance goals, and regularly provide this information to senior management as well as to billing office staff.
• Strong verbal and written communication skills required.
Job :
FinanceOrganization :
Health First Medical Group LLCPrimary Location :
United States- Florida – Brevard County- MelbourneSchedule :
Full-timeShift Times :
8:00 am – 5:00 pmJob Level :
Manager
