Lead Business Office Specialist, RMF Revenue Cycle

DHR Health - US:TX:Edinburg - Days

Summary:

FLSA STATUS: Exempt Non-Exempt

MISSION STATEMENT:

Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.

VISION:

Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.

POSITION SUMMARY:

This position is responsible for business office activities which include collection of accounts receivable, patient billing, customer service, cashiering, refunds/recoupment's, appeals, and provides refunds for services to patients and third party payers as needed. This position requires that at least three (3) of the functions above are able to be performed.

As lead, this position involves providing daily support, guidance, mentoring and real time feedback to Billing Office Specialist, monitoring team performance, facilitating of onboarding/training new/existing team members, assisting to resolve complex billing issues, and serving as a liaison between staff and leadership to collaboratively identify training needs and drive continuous improvement initiatives.

POSITION EDUCATION/ QUALIFICATIONS :

· High School Diploma/GED is required

· Comprehensive knowledge of healthcare reimbursement.

· Understands medical terminology

· Familiarity with EOB’s and RA’s

· Knowledge of Microsoft Office suite, working knowledge of Excel required.

· Excellent Customer Service

· Good written and verbal communication skills required

· Must be able to multi-task

· Ability to read, write and speak English

· Ability to communicate clearly and concisely with all levels of management

· Bilingual – English/Spanish, preferred

JOB KNOWLEDGE/EXPERIENCE :

· Previous healthcare experience (2-3 yrs.) required, hospital experience preferred.

· Communicates clearly and concisely and is able to work effectively with other employees, patients and external parties

· Establishes and maintains long-term customer relationships, building rapport with other department staff

· Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is required.

· Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.

· Medical Terminology, ICD-9, ICD – 10, Codes, CPT Codes, HCPCS code, Modifier knowledge required.

· Ability to use the internet to obtain information from Third Party Payers or other sources is required.

· Requires working with minimal to moderate interruptions

· Requires reasoning ability and good judgment.

· Ability to handle pressure, meet deadlines, and remain productive in challenging situations.

Responsibilities:

POSITION RESPONSIBILITIES:

· (List of job duties) Serve as a point of contact and resource for Billing Office Specialists (BOS) and Customer Service staff by providing daily support, guidance, and mentoring.

· Facilitate the onboarding and training of new team members and retraining of existing team members by providing hands-on instruction, sharing knowledge, and helping to reduce the learning curve.

· Promote collaboration and team cohesion by fostering a positive work environment that encourages open communication and problem-solving.

· Monitor team performance and provide real-time feedback and coaching to support individual and team development.

· Consistently performs all BOS responsibilities at a high level of accuracy and efficiency.

· Assist in resolving complex billing and collection issues by supporting staff with escalated questions from patients, carriers, or other departments.

· Act as a liaison between staff and leadership, communicating updates, changes in procedures, or process improvements effectively.

· Collaborate with supervisors and managers to identify training needs, create learning materials, and support continuous improvement initiatives.

· Maintain a high level of knowledge regarding payer guidelines, hospital policies, and billing system tools (e.g., Cerner, Medisoft, Paragon, etc).

· Ensure the team adheres to compliance standards and HIPAA regulations at all times.

· Support staff in reviewing and analyzing accounts, EOBs, RAs, and balances to ensure accurate follow-up, billing, adjustments, and refunds.

· Encourage use of best practices in documentation (notes tab, tickler system, etc.) and insurance communication strategies (e.g., collection tips booklet).

· Participate in departmental projects and initiatives, providing insights from the frontline to help improve workflows and outcomes.

· Assist leadership with workload distribution and provide coverage for BOS tasks during absences or peak times.

LINES OF REPSONSIBILITIES :

(Chain-of-command) Chief Ambulatory Officer 2. VP of Revenue Cycle 3. Director of Revenue Cycle

Other information:

CUSTOMER SERVICE:

Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service.

AGE SPECIFIC :

Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age.

AMERICANS WITH DISABILITIES ACT: (ADA) :

A. Essential Duties : Indicated by bold print within performance standards, preceding individual numbered criteria.

The following table provides physical requirements that will be associated with, but not limited to, this position:

B. Working Conditions : The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents.

C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.

D. Aptitudes : HIGH 1 2 3 4 5 6 LOW

Intelligence: General learning ability: The ability to “catch on” or understand instructions and underlying principles. Ability to reason and make judgments. 3

Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively. To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3

Numerical: Ability to perform arithmetic operations quickly and accurately. 2

Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to “visualize” objects or two or three dimensions, or to think visually of geometric forms. 2

Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3

Clerical Perception: Ability to receive pertinent details and verbal or tabular material. To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation. 2

Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3

Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3

Manual Dexterity: Ability to move hands easily and skillfully. To work with hands in placing and turning motions. 3

Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3

Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3

I have read and reviewed my job description with my supervisor or designee and I understand the job I am expected to perform.

If applicable ____________ certification will be completed within _________ time frame of hire/transfer date.

Employee Signature: ________________________________ Date: ____________________

Transfer/Hire Date Effective: ________________________.