Summary

Oversees and facilitates Central Business Office (CBO) staff and work activities related to one or more of the following: billing claims, posting payments and adjustments, variance analysis, and third party follow-up. Maintains appropriate internal control over assigned area and continuously monitors to ensure full realization of revenue. Participates with CBO leadership team in the research, development, implementation, evaluation, and revision of polices and procedures related to billing, coding, managed care, financial counseling, insurance verification and reimbursement/coverage guidelines. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

Education/Experience/Licensure

Knowledge/Skills/Abilities

• Knowledge of Medicare/Medicaid and commercial/managed care payer regulations.
• Knowledge of all applicable compliance requirements.
• Excellent communication and diplomacy skills.
• Strong leadership competencies.

Key Job Responsibilities

• Works closely with Manager, payer representatives, and technology partners to ensure all facets of EDI (electronic data interchange) and lockbox operations are functioning as expected so insurance claims are filed appropriately.
• Monitors and communicates findings of third party follow-up to Manager and Practice Liaison to optimize performance at the CBO and in front-end operations at member practices.
• Works closely with Manager to analyze output and develops results reporting related to applicable areas of responsibility.
• Develops denial prevention strategies and assists Practice Liaison with the implementation of denial prevention strategies.
• Analyzes and communicates payment variance trends and addresses payer issues with Manager and Managed Care executives to optimize revenue realization.
• Coordinates clerical support needs with manager and others to ensure timely and accurate filing, scanning, mail distribution, correspondence processing, etc.
• Reviews AR reports and data to identify unfavorable trends and initiates corrective action as required to meet key performance indicators.
• Monitors measures and reports productivity of direct reports and develops ongoing performance improvement plans as needed.
• Manages patient satisfaction issues as they arise by coaching staff or directly intervening.
• Manages work-flows of direct reports and guides performance towards best practice metrics.
• Maintains and develops a competent, productive and quality conscious workforce by hiring, evaluating performance, counseling, training, issuing corrective action, and recommending promotion or discharge of department personnel according to the MLH value system.

Physical Requirements

• The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.
• Must have good balance and coordination.
• The physical requirements of this position are: light work - exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.
• The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.
• The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative work.