This individual is responsible for ensuring and enforcing billing and collection policies and procedures according to Governmental and non Governmental regulations. Establishes, implements, and monitors short- and long-term goals for the department which are in line with the organization's strategic plan, mission, vision, and values. This position will have a collaborative role with the Centrastate partnership including the Epic implementation. This position will work extensively and collaboratively with the Managers of Patient Financial Services (PFS) and will report directly to the Director, PFS. You will be managing a team of up to 26 employees. • Oversight of billing and collections procedures for all payors payors ensuring claims submitted are in accordance with regulatory requirements and acceptance rate is maintained at an acceptable level while ensuring errors are identified and resolved timely • Works closely with the various departments to ensure all Governmental and non Governmental audit requirements are met and are compliant and ensuring timely response to audit requests • Works collaboratively with the Managers of PFS to maintain a thorough and up to date knowledge of payor reimbursement practices and procedures including Medicare & Medicaid regulations, as well as Managed Medicaid requirements • Troubleshoots any issues and escalates timely • Develop and review detailed policies and procedures, training and workflow documentation. • Routine meetings with PFS Managers to review payer performance • Routine meetings with the PFS Managers and Director to ensure all governmental regulations are being met and audits are completed timely. • Identifies and participates in continuous quality improvement initiatives across the billing team and other functional areas to streamline processes. • Implement specialized program/billing requirements including planning and implementation as issued by CMS • Maintains open communications with the Director of Patient Financial Services and Subordinates keeping all informed of progress on goals, issues, solutions, or any other significant factors affecting the Patient Financial Services Department • Maintains an open relationship with other Managers to optimize processes as needed • Responsible for overseeing all Billing Audits including all COVID related audits in the future. • Work with our PWC audit team to provide support when needed.
Qualifications for Internal Candidates
Must possess a comprehensive knowledge of revenue cycle functions and systems and minimum of three (3) years of experience within the area of revenue management, specifically experience with Account Billing and Follow-up or other functions related to revenue cycle activities.
Must possess knowledge of all Governmental and non Governmental regulations.
Management experience required.
1. High School diploma required, Bachelor's Degree preferred
2. Minimum of 5 years experience in a hospital billing setting
3. Proven leader with excellent human relations skills
4. Embraces change by being able to change focus and adapt to new enterprise strategies while encouraging development of the team and leading them to success