ESSENTIAL DUTIES AND RESPONSIBILITIES:

(The following statements are illustrative of the essential functions of the job and do not include other non-essential or marginal duties that may be required. Community Hospital reserves the right to modify or change the duties or essential functions of this job at any time. All responsibilities may not be performed by all incumbents.)

1. Responsible for revenue cycle management accounts receivable quality, service levels and associated performance management to ensure progress to meet Accounts Receivables (AR) and departmental goals.
2. Organizes and supervises staff to work in accordance with operating protocols to achieve maximize efficiency. Assists with the evaluation of ongoing operations and programs on a regular basis for efficient use of resources.
3. Sets performance standards and goals for direct reports and the department; evaluates and counsels’ staff on their performance along with development opportunities for staff growth.
4. Fosters a collaborative and highly accountable culture that results in high levels of internal and external customer satisfaction, billing accuracy and cash collections for physician billing.
5. Acts as a liaison and advocate between accounts receivable and other departments including vendor support as needed.
6. Responsible for driving process improvement initiatives related to front end revenue cycle functions, in collaboration with the Practice Directors and Executive Director of Physician Practice.
7. Responsible for denial code work file management by coders, ensuring timely submission of charges. Develops encounter forms for each physician practice to ensure all services provided are captured on fee Reviews encounter forms at least twice a year to ensure appropriateness of ICD-10 and CPT codes.
8. Coordinates and facilitates compliance audits for the department. Directs internal compliance reviews conducted by the department coders. Provides feedback and education to physicians on coding errors for both procedure and E&M services. Verifies that fee schedules are appropriate against insurance payers' allowable
9. Serves as a key resource for changes in payment and coding guidelines from all Educates and reeducates them on these continual updates. Responsible for constant and continual education of the physicians on coding changes.
10. Facilitates and influences the credentialing process to assure prompt ability to bill for services rendered by newly hired
11. Analyzes monthly Appeals reports, tracking work effort to ensure collections activity on a regular basis. Analyzes weekly charges and payments data to ensure the physician practices are meeting established targets for productivity. Reviews EOBs as needed to determine/address payer problems. Coordinates efforts regarding authorization
12. Review all Medicare and other episodic payers’ clinical records at the local level to assure appropriate documentation for reimbursement. This review includes verification of appropriate documentation, quality of care provided, visits utilization, appropriate contacts with physicians, adherence to the care plan, and evidence of communication between
13. Oversee the maintenance of clinical records and files to comply with Conditions of Participation (COPs), using measurements, as licensure, certification, and accreditation results.
14. Oversee the maintenance of clinical records and files to comply with Conditions of Participation (COPs), using measurements, as licensure, certification, and accreditation results.
15. Be accountable for financial responsibility related to budget goals through utilization, documentation, providing appropriate and accurate patient care, case mix weight, and appropriate utilization of delivery of patient
16. Review documents for accuracy and completeness prior to locking and submitting data electronically. Explain and mentor clinicians and staff on COP’s and on billable skilled visits. Educate and mentor clinicians one on one regarding concerns, questions, accuracy of data, and other related documents, that are being reviewed.

EDUCATION and/or EXPERIENCE:

Bachelor’s degree in finance, economics or related field with five (5) years of related experience and two (2) years of management experience. Previous supervisory experience in billing and collections in a hospital or medical group

OR

equivalent combination of education and experience.

This position's pay range is: $46.00 - 52.90 per hour, depending on education and experience.

Discretionary bonuses, relocation expenses, merit increases, market adjustments, recognition bonuses and other forms of discretionary compensation may be paid to eligible employees based upon organizational and individual performance.

Benefits:

Employees are eligible to participate in an attractive benefits package including medical, dental, vision, paid time off, education assistance, 403(b) with employer matching, and more. Eligibility is based on employment status. Details regarding specific benefit you may be eligible for will be discussed during the hiring process.

Be Extraordinary. Join Us Today!