Manager Billing and Accounts Receivable at Crouse Hospital – Syracuse, New York

The Manager is responsible for managing the daily operations and related reporting associated with billing, claims management, account collections, insurance follow up, clinical and technical denial resolution, to insure the successful submission and payment of accurate, compliant and timely patient account claims for all hospital system services lines. This is including but not limited to; timely and accurate insurance authorization and verification for services, timely electronic and paper claims billing transmissions, management and resolution of the returned or claims held for missing or invalid billing data, compliance with all billing and reimbursement rules and regulations for both governmental and non-governmental payers, and management of Hospital charge/description/service master.

FUNCTIONAL JOB DUTIES AND RESPONSIBILITIES:

1. Responsible for the overall operations, leadership, direction and coordination of staff within the designated area(s) of responsibility.

2. Coordinates department activities and interactions with other departments on an on-going basis.

3. Attends and actively participates in hospital or medical performance improvement councils and committees as requested.

4. Proactively communicates with staff and keeps them informed on a regular basis or as needed; updates staff regarding policy changes in specialized areas.

5. Develops and utilizes department policy statements, scope of service, quality indicators and updates; revises as necessary.

6. Performs staff management functions related to employee selection, on-boarding/orientation, coaching/development, staffing, work assignments, performance management and goal alignment as guided by hospital policy and procedures and collective bargaining unit agreement (when applicable).

7. Participates, collaborates and actively engages in meetings to achieve goals and mutually beneficial outcomes.

8. Conducts regular staff meetings to disseminate hospital and/or department/division information and allows for discussion of staff concerns needing clarification or resolution.

9. Effectively functions as a liaison among Hospital departmental billing efforts and quantifying and addressing major charge, billing and reimbursement matters negatively affecting the ability to produce timely clean claims and subsequent cash collections.

10. Maintains complete knowledge of state and federal and contracted third party regulations for billing and reimbursement for all payers. Informs direct report of any opportunities available to enhance reimbursement in accordance with billing regulations. Successfully resolves matters with third party payers precluding optimal claim submission with third party payers.

11. Continually reviews billing, collection and claims resolution processes and systems to determine the most effective and efficient methods and systems to insure workstream success. Drives and implements change as necessary.

12. Monitors bill holds at all sources and insures timely resolution. Works with other departmental managers to resolve. Reports unresolved issues and concerns impeding the billing process.

13. Acts as a liaison with the electronic billing vendor/clearing house insuring contract performance as specified. Periodically reviews other competitive products.

14. Oversees and assists in performing chart to charge reviews on a quarterly basis to insure compliant claims.

15. Prepares daily/weekly/monthly reporting of pertinent activities to best practice indicators.

16. Plans effectively, enforces productivity and quality standards and ensures there is sufficient staff to perform the duties and responsibilities of the billing function.

17. Reconciles daily bill transmissions from the host to the clearing house and from the clearing house to the payers. Takes appropriate action to resolve and reconciles any and all transmission variances to insure all claims are successfully transmitted.

18. Is the system "super user" and acts as a resource relative to system application and usage.

19. Alerts direct report of any issues, concerns and/or negative trends.

20. Monitors payment variances, contract or otherwise. Reports trends and/or payer issues and works with contract management staff to resolve trending issues.

21. Establishes relationships and ongoing communications with payers to quickly resolve account payment concerns and issues. Elevates issues when necessary and appropriately both from a management as well as a regulatory perspective.

22. Effectively provides direction, cross training and policy interpretation to staff in managing their respective areas of accountability and offers advice in handling operational and administrative concerns.

23. Motivates staff in a positive manner and supports teamwork. Is kind, courteous, respectful and professional in all interactions with all hospital staff at all levels.

24. Attends pertinent seminars, internal and external meetings, participates in appropriate knowledge resource to insure up to date knowledge base and shares obtained information with Business Office and institutional personnel.

25. Develops new employee job specific training materials, policies and procedures, reference guides and provides initial and on-going training as necessary.

26. Complies with patient confidentiality policies for the retention of patient health information, or when handling, distributing, or disposing of patient health information.

27. Prepares other relevant reporting as assigned.

28. Assumes other duties as assigned by department leadership.

MINIMUM EDUCATION / CERTIFICATION / LICENSURE:

• Bachelors degree in related field required. Masters degree preferred.
• A minimum of three (3) years health care experience in a business office setting related to billing and accounts receivable.
• Previous leadership experience preferred.
• Working knowledge of MS Office.
• Familiarity with healthcare medical terminology and coding.
• Knowledgeable in reimbursement methodologies for all major third party and governmental payers; Medicaid, Medicare, HMO’s; Commercial, Worker’s Compensation and Third Party Liability.