Manager - Transplant Service Revenue Mgmt. (Detroit, MI)

This position is a full time daily in person work format at the main hospital campus in Detroit.

GENERAL SUMMARY: 

As a member of the Transplant Institute and hospital revenue cycle team, manages, coordinates or participates in a wide variety of operational and personnel functions related to Insurance Verification, Medicaid Application Services, Registration Services, EC2000 and other related “front-end" and billing processes. This includes scheduled as well as emergent services for inpatient, outpatient and ambulatory surgical encounters. The manager will have a comprehensive knowledge in a wide range of revenue cycle processes and systems. Plans & directs day-to-day operations. Key player in the development and implementation of revenue cycle improvement processes as well as metrics to measure performance. Participates in quality assessment & continuous quality improvement activities. Performs other responsibilities to ensure an efficient and customer-focused operation. 

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Manage day-to-day administrative & operational functions of the revenue cycle through the supervision of multidisciplinary staff.
• Coordinates with key revenue cycle departments including ATMO, DEM, Clinic and OR to assure successful business processes fit and perform within required clinical needs resulting in appropriate reimbursement for the Hospital and System.
• Manages complex projects that include participating with multi-disciplinary process improvement teams from across the System.
• Manage receivables for inpatient Medicaid applications, insurance rejections and pending accounts.
• Plan and direct daily operation of securing insurance authorizations, COB, Charity Care, and other related information for all urgent, scheduled and ambulatory procedures.
• Assist department Vice President in developing and implementing the departmental budget. Recommend the acquisition of equipment, renovations and staff. Ensure adherence to budgetary guidelines.
• Track, trend and monitor billing rejections to develop strategies required to manage EC2000 and ambulatory billings.
• Review patient accounts and authorize billing of late charges based on insurance reimbursement guidelines.
• Develop and implement cash collection policies for outpatient, inpatient and ambulatory procedures. Communicate policies and collect payment from patients.
• Interview, hires, schedules, assigns work to, evaluates, disciplines &, when necessary, recommends discharge of departmental personnel. Completes timely performance appraisals. Ensures compliance with departmental and organizational policies & procedures.
• Assist the department leadership with overseeing all quality assessment and continuous improvement activities.
• Designs, implements & conducts educational programs for staff regarding changes and updates to third party requirements impacting the revenue cycle and customer service initiatives.
• Develop and implement departmental policies and procedures to achieve revenue cycle objectives.
• Conducts meetings with departmental personnel and other divisions within Hospital Revenue Cycle to communicate information and facilitate improvement opportunities.
• Participates in plans to assure hospital admission consents are secured in a timely manner and implements and manages processes to a achieve success.
• Analyze data to identify patterns and trends of performance. Addresses process performance issues and implements improvement plans.
• Track, trend and monitor information to determine strategies needed to meet weekly/monthly departmental goals.
• Works in collaboration with the System's Contracting Department to review, discuss and monitor managed care contracts and performance.
• Collaborates with the Contracting and Central Business Office Department leadership to reconcile accounts relating to insurance payments and adjudication.
• Reviews and reconciles transplant surgical denials and appeals.
• Serves as an educational resource person to validate and communicate the through-put processes for transplant insurance experiences and the various impacts on revenue cycle performance.