The Manager, Business Office and HIM, is a tenacious revenue cycle enthusiast who collaborates with the clinical, financial, billing, and coding teams to drive outcomes and assure appropriate reimbursement. Responsible for overseeing and directing the activities and staff in business office and health information management departments. Enjoy moving between understanding current processes and leading the team to drive outcomes. Ideally has experience in clinical care setting, telehealth, remote patient monitoring, and understands the intricacies of fee-for-service and value-based payment methodologies, along with systems that care for vulnerable populations. Comfortable working independently in an ambiguous environment that can experience rapid growth and changes quickly.
Our team is passionate, driven, collaborative, intellectually curious, and excited about the opportunity to be a part of a Patient Centered Medical Home (PCMH) organization during a time of transformational change in healthcare. We're inspired by our medical providers and seek to create a platform that recognizes, utilizes and supports their vital role caring for the patients and communities we serve. We strive to continuously explore, learn, and achieve results.
PRIMARY RESPONSIBILITIES AND DUTIES
- Establish standards of excellence and quality for Brown Clinic business office and health information.
- Work with leadership to develop policies to ensure revenue cycle efficiency
- Create “key performance indicators (KPIs) for revenue cycle management, monitor performance and implement improvement
- Takes ownership of billing and collections and collaborates with leadership to resolve issues/problems in a timely manner and prevent their recurrence
- Drive processes that achieve financial results for billing, collections and payment processing. This will include timely charge entry/capture, billing/claims submission and payment posting
- Review and ensure timely follow-up on outstanding items and assist in the resolution of billing audits
- Conduct and oversee denial analysis, implement denial reduction initiatives and reduce overall denials
- Partner with others to ensure timely, accurate, and compliant billing and coding activities
- Negotiate/Manage various health plan contracts and associated credentialing processes for timeliness and appropriate payment objectives
- Assist in hiring, training, and measuring and managing productivity of the team
- Help identify inefficiencies and create and implement process improvement activities
- Serve as an internal consulting resource on revenue cycle management
- Must be able to communicate effectively verbally and written.
- Excellent customer service and phone etiquette skills.
- Must be able to maintain a high degree of confidentiality and work well under productivity standards.
- Able to prioritize and balance workload on short and long-term company needs.
- Must be able to work independently and be able to solve problems efficiently and accurately.
- Able to create channels of communication to obtain information necessary to perform job tasks.
- Strong organizational skills with the ability to prioritize a high-volume workload.
- Advanced computer knowledge and proficiency required.
- Highly proficient Excel user necessary for analyses and reporting, including proficiency with Excel pivot tables.
- Familiarity with preparing dashboard reports that track performance indicators
- Continually looks for opportunities to automate routine RCM tasks through technology. In conjunction with leadership, oversees the implementation of automation/technology projects.
- Utilize and become highly proficient with eCW, the principal EMR and practice management/billing system, as well as become proficient with Trizetto clearinghouse systems.
- In conjunction with leadership, develop KPIs and dashboard reports to monitor and benchmark RCM performance. Set internal goals for KPI metrics. Prepare and distribute monthly KPI reports to leadership, flagging performance metrics that are lagging benchmarks or internal goals.
- Develop and implement improvement plans for underperforming KPI benchmarks and internal goals.
- Monitor credit balance reports to ensure accurate and timely refunds. Monitor RCM Department to ensure compliance with applicable timely refund requirements.
- Develop and monitor denial management system, whether automated or manual.
- Develop and/or monitor system to confirm payer reimbursement conforms to contracted (expected) rates or governmental fee schedules.
- Serve as the subject-matter expert (SME) on regulatory, compliance, and legal requirements associated with medical billing. Ensures compliance with relevant regulations, standards, and directives from regulatory agencies, governmental and third-party payers.
- Communicate relevant payer policy changes and updates to clinic operations.
- Assist in the development, periodic revision, and implementation of the Billing & Collection Policies and Procedures Manual.
- Supervise others to contact payers to identify and resolve account collection problems for maximum collection results.
- Work with Team Leads and HR Department in managing activities of the department in regards to recruiting, hiring, termination, training, professional development, mentoring, counseling, and performance evaluations.
- Foster a strong culture of accountability, teamwork, collaboration, and operational excellence within the department.
- Promote relevant continuing education and training for team leads and staff members.
- Assume responsibility for analyzing existing payer agreements for appropriate reimbursement and initiating prioritized contract renegotiations with payers when appropriate.
- Other duties as assigned or needed.
APPLY NOW - To apply for a position(s), complete one of the following options: Online Application, PDF Application or Word.DOC Application. For more information on becoming a member of the Brown Clinic team, contact Human Resources at 605-884-4247 or click here.
- Bachelor’s degree in Business Administration, Accounting or related field is required.
- Minimum of two years of progressively responsible supervisory experience in a business
- A working knowledge of insurance diagnosis coding, accounts receivable, claim requirements, electronic billing procedures, and cash posting functions, managed care contract reimbursement, secondary billing, unidentified cash, and patient liability.
- Respect for and ability to follow Clinic’s Confidentiality Policy.