To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
Working within Corporate Professional Business Services (CPBS), oversees revenue cycle functions of Northeast Medical Group (NEMG) and works with internal CPBS staff to ensure all services are billed timely and accurately. Ensures follow-up is completed on denials and outstanding receivables to maximize cash flow. Ensures positive interaction with third-party representatives and managed care companies to facilitate operations and promotes good customer relations in the work environment. Maintains thorough knowledge of up-to-date government and State regulations which affect the professional revenue cycle, follow-up and reconciliation of healthcare accounts receivable procedures in order to assist staff members when necessary. Ensures the efficient and accurate use of the computerized account receivable systems. Analyzes and makes recommendations to enhance systems.
- 1. Manages and oversees several functional areas of CPBS, which may include: Pre-A/R (Ensures accurate charge capture /coding and timely billing of all PB charges); Accounts Receivable & Denial Management (Management of NEMG accounts receivable, and timely response to claim denials along with unresponded claims); Appeals (Ensure timely filing of claim appeals at various levels based on payer specifications and guidelines); Payment Variance (Ensures accurate payment for services based on provider enrollment and third-party payer contract specifications); Customer Experience. (Ensures that each patient / customer request is handled in a consistent, professional and friendly manner, which results in a positive customer experience; and Cash Management: (Ensures that all payments and remittance files (Insurance and Patient) are posted in a timely manner and reconciled to bank deposits.
- 2. Establishes performance standards related to the above functions, and routinely evaluates departmental and staff performance.
- 3. Works with all levels of CPBS, Finance, and NEMG to monitor charge review process at the practices. Advises NEMG Operations team of the payer relations updates on polices, trending claim issues, and EPIC workflow to reduce denials and improve revenue collections.
- 4. Develops and modifies billing policies and procedures as part of billing optimization. Works closely with NEMG leadership to ensure the provider enrollment process for all NEMG provides is completed in a timely fashion in order to achieve patient revenue objectives.
- 5. Manages the medical coding for physicians, coders and biller education program. Serves as a resource for physicians and office coordinators to obtain information and clarification on accurate and ethical billing standards, guidelines and regulatory requirements.
- 6. Represents NEMG at YNHH system meetings for reference updates from Centers for Medicare and Medicaid Services and reporting provisions.
- 7. Monitors performance of CPBS revenue cycle, identifies trends and issues, develops and implements processes to improve performance.
- 8. Independently resolves any questions on patient accounts outstanding balances, free care /sliding scale programs, and settlement discount approvals. Monitors Medicaid Pending accounts and write-off adjustments on monthly basis.
- 9. Develops and implements billing and collections policies and procedures to enhance NEMG practices collection ratios.
- 10. Represents NEMG in Subcommittees to support, strategize, develop and implement the project work plan for coding, education and improved clinical documentation.
- 11. Member of NEMG Compliance and Privacy Committee to provide input into the development of compliance policies and procedures and related educational materials and receive and recommend for approval the local compliance audit plans.
- 12. Responsible for cash receipts, deposit, lock box, and credit card activities for all of NEMG in CT, RI and NY State.
- 13. Oversees the preparation and coordination of the documents for the NEMG internal and external audits. Provides both internal and external auditors with requested information based upon client assist list.
- 14. Responsible for oversight of the NEMG and Century Financial Services relationship. Monitors collection accounts for community physicians before transfer to Century Financial Services. Processes monthly Century invoices and payments. Processes Legal Letters for collection accounts ready to go to legalization.
- 15. Manages recruitment, orientation and training of new staff.
- 16. Approves staff payroll and check requests.
- 17. Participates in appropriate seminars and in-services and maintains knowledge of medical billing, operations and finance.
- 18. Leadership Responsibilities: Provides guidance and support to staff and ensures that work is completed efficiently and correctly; Actively participates in and supports the development, mentoring and coaching of staff. Conducts timely performance reviews on assigned staff, counsels and develops performance improvement plans as required; Responsible for delegating work to assigned staff and establishing workflow standards. Sets up regular staff meetings to discuss important issues and performs quarterly one-on-one employees meetings.
Bachelor's Degree in Finance or related field required.
Minimum of five (5) years' experience in physician billing and collection required.
Demonstrated research skills. Demonstrated accounting and reconciliation skills. Strong verbal and written communication skills. Ability to assess workflow and make recommendations to improve processes; ability to effectively implement changes in process across an organization.