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Manager, Centralized Charge Control - Primary Physician Network-CBO - Full-Time at Mercy Medical in South Bend, Indiana

Posted in Other 30+ days ago.

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Job Description:

14001_54620 SJPN Patient Financial Service
Expected Weekly Hours:
Day Shift

Position Purpose:
Provides leadership and day-to-day operational management for local hospital(s) and/or Medical Group Provider Services MGPS centralized charge control functions. Responsible for motivating staff to achieve the highest levels of performance, working in conjunction with all key stakeholders to secure and maximize revenue for the region. Manages charge capture for complex service lines and/or for Provider services outside of the clinic and oversight for all charge revenue generating departments. Optimizes staff performance and revenue through process redesign, policy/procedure implementation, communications, continuing education and professional development activities, staff empowerment and feedback.

As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs.

Job Description Details:

Minimum Maximum

Actively demonstrates the organization's mission and core values and conducts oneself at all times in a manner consistent with these values. Knows and adheres to all laws and regulations pertaining to patient health, safety and medical information. Ensures organizational compliance specific to federal guidelines and Regional/Trinity Health policies and procedures specific to revenue integrity and revenue cycle operations:Works directly with the Revenue Integrity and Optimization leader to mitigate any compliance risks in a timely and efficient manner in accordance with the organization's compliance program and healthcare billing/coding guidelines issued by the Center for Medicare & Medicaid Services or any other regulatory body.

Tracks risk exposure incidences and calculate the financial impact based upon approved processes designed to resolve/reduce compliance risks and reports them to the appropriate persons based upon organizational policies.

Identifies and develops focused approach to ensure appropriate charge capture:

Ensures proper charge capture practices are implemented consistently across the organization

Develops and implements operational processes to ensure timely and accurate charge entry for supported services in an efficient and effective manner that assist in the reduction of charge capture related denials

Conducts quality and productivity reviews (at minimum monthly) to ensure appropriate and accurate charging practices are in effect.

Takes appropriate action based upon quality and productivity reviews to return the team's performance to best practice standards including operational, scheduling and personnel changes as needed.

Oversees continuing education efforts for staff as needed based upon on billing and charging processes guided by coding, compliance and regulatory guidelines specific to their services.

Works with clinical leadership as needed to make certain all revenue cycle related needs for a clinical department are met.

Works with all areas of the revenue cycle process including coding and billing to resolve issues as needed.

Routinely evaluates and documents the revenue capture process for each department and identifies process improvements. Collaborates with the Revenue Integrity and Optimization leader on Charge Description Master (CDM) changes that may be needed for compliant charge capture. Monitors Medicare and Medicaid web sites, as well as payer websites and newsletters for changes impacting charging, coding and billing. Prepares and conducts educational services to departments and staff pursuant to audit findings, regulatory changes and requirements, coding updates, and managed care billing requirement changes. Manages the development of colleagues work schedules to ensure cost effective staffing that meets customer requirements and quality performance. Manages team projects and fosters interdisciplinary and intra department collaborative relationships. Develops effective decision-making, communications and interpersonal relations. Ensures problem resolution and corrective action for long-term solutions, manages such efforts across intra and inter-departmental channels. Elicits feedback from interdisciplinary teams, including the medical staff, and collaborates on decision making as appropriate. Formally assesses the developmental needs of the department on a periodic basis and promotes opportunities for development in independent decision-making, effective communications and interpersonal relations to ensure customer satisfaction in conjunction with Trinity Health's core values and to foster team spirit. Identifies and implements opportunities for colleague to increase their knowledge base, advance their practice and enhance their professionalism through colleague orientation and continuing education opportunities. Responsible for hiring employees and recommends allocation of resources based on scope of goals and priorities. Monitors and conducts performance appraisals, including review and approval of performance goals, manages regular ongoing performance feedback, and may terminate positions when necessary. Provides feedback in a prompt, direct and positive manner; mentors and coaches colleagues to ensure positive outcomes. Provides counseling and/or conflict resolution regarding unresolved performance issues, demonstrating effective use of the disciplinary process. Analyzes and displays data in meaningful formats; develops and communicates policies/procedures and other business documentation; manages and conducts special studies and prepares management reports, including Key Performance Indicators as they relate to the department. Performs other duties consistent with purpose of job as directed.

Trinity Health's Commitment to Diversity and Inclusion

Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.