SCOPE / GENERAL PURPOSE OF JOB:
Responsible for managing the daily functions of the AR Department in accordance with RC Billing standards and Reimbursement policy and procedures. Responsible for timely submission of all adjustments; directly supervises accounts receivable(s) actions to ensure timely and accurate productivity; generates and analyses monthly reports and ensures their accuracy; maintains benchmark metrics per client and overall company, solves problems identified based on metrics and AR reviews and improves efficiency within the AR Department operations while ensuring cash goals are obtained, the lowest possible accounts receivable aging, and the lowest possible DSO. Ensures the delivery of high quality professional services that brings tangible results to RCB billing clients.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
· Directs the daily operation of the AR Department to ensure accuracy and timeliness of AR resolution for all clients.
· Ensures that daily, weekly, and monthly AR functions are performed and accurate.
· Ensures all AR staff are properly trained, RCB policy and procedures, Allscripts Misys/Tiger, Allscripts Pro PM, Practice EDI Insight, File Bound, CCL, Radiation and Medical Oncology Coding, Etc.
· Demonstrates thorough understanding of and oversees all aspects of monitoring and interpreting insurance reimbursements and implementing procedures that ensure optimum collection in a manner compliant with Federal and State regulations and RC Billing policy and procedures.
· Works in tandem with the management team to perform timely month-end close for all clients.
· Monitors aged accounts receivable for insurance and patient responsible amounts; ensures that the proper processes are followed and ensures that aging accounts are maintained within RC Billing standards.
· Prepares monthly AR work plan per client, disseminates to staff, follows thorough to ensure accurate and timely AR resolution is sought to the plan
· Prepares monthly financial analysis on accounts receivable, collection percentages, billing statistics, etc. for reporting and discussion with Director, Associate Director and President.
· Communicates with client as necessary, but not less than monthly; physicians, administration and business departments, Schedules monthly conference calls with clients to discuss the prior months financials, issues identified, issues resolved, etc.
· Implements and ensures a strong knowledge and compliance with RC Billing Reimbursement Policies and Procedures to maximize efficiency. Ensures compliance with appropriate industry regulations and State and Federal regulations.
· As it relates to AR resolution ensures computer master parameters including CPT-4 and ICD-10 code files, fee schedules, insurance, physician, etc. are accurate. Works with the Associate Director for updates and file maintenance.
· Assists the budgetary activities of the CBO with the President.
· Ensures strong professional communication and working relationship with the CBO Management team.
· Recruits, hires, and supervises AR staff; assists with developing and attaining performance goals and objectives.
· Assists with periodic operational assessments of the billing office (SSAE 18 Audit) in order to maintain consistently efficient operations and determine if process improvements are needed.
· In coordination with the President assists in facilitating the implementation of new billing clients successful go live.
· Designs, presents training programs for process implementation with the CBO staff
· Attends administrative meetings and participates in committees as requested. Conducts special projects and studies as directed.
· Develops and maintains benchmarks per client billing classification and presents to President monthly for review, discussion and action plan for achieving goals established. ie. Proton, global, PC or TC
· Evaluates AR staff performance and recommends merit increases, promotions, and disciplinary actions.
· Maintains working knowledge of Radiation and Medical Oncology billing and coding guidelines.
· Maintains working day to day knowledge of the practice management system Allscripts Misys Tiger and Allscripts Pro PM.
· Monitors daily denials and maintains working day to day knowledge of the denial resolution processes in Practice Insight and Allscripts Pro PM.
· Maintains working knowledge of applicable laws and regulations as they relate to assigned responsibilities.
· Maintains confidentiality of all information related to patients, medical staff, finances and cost effective health care delivery issues.
· Strives to achieve and maintain company Days Sales Outstanding and Account Receivable Aging standards.
· Assists in the development of and primary responsibility for maintaining productivity standards relating to Accounts Receivable resolutions.
· Additional Duties as Assigned
EDUCATION AND/OR EXPERIENCE:
· Baccalaureate degree in business administration or related field and
· Minimum ten (10) years medical billing office/reimbursement management experience.
· Knowledge of fiscal management and human resources management practices.
· Knowledge of organization policies and procedures.
· Knowledge of health care administration principals.
· Knowledge of business office procedures
· Previous managerial experience required.
· Knowledge of insurance agency operating procedures and practices.
· Knowledge of business management and basic accounting principles as they relate to accounts receivable management.
· Knowledge of computer accounting programs, Excel spreadsheet development and office applications.
· Knowledge of medical terminology, coding and office procedures.
· Knowledge of third-party and insurance company operating procedures, regulations and billing requirements and government reimbursement programs.
· Skill in accounts receivable management, including reimbursement, coding and billing procedures.
· Excellent analytical skills and ability to understand statistical and financial analysis.
· Skill in understanding RC Billing’s strategic business objectives and interpreting them with respect to billing office performance and results.
· Ability to handle pressure and remain calm in busy situations.
· Ability to demonstrate commitment to work and consistent job performance.
· Ability to proactively recognize trends and/or errors then evaluate, establish and execute action plan for immediate resolution and revise policy and procedures where needed to eliminate the issue on a go forward basis.
· Ability to conceptualize workflow, develop plans, and implement appropriate actions.
· Ability to maintain confidentiality of sensitive information.
· Ability to delegate responsibility and authority to staff.
· Ability to work creatively with management and staff to achieve objectives.
· Ability to communicate clearly.
· Skill in exercising initiative, judgment, discretion and decision-making to achieve RC Billing’s objectives.
· Skill in identifying and resolving problems.
· Ability to communicate effectively regarding fiscal policies.
· Ability to establish and maintain effective professional working relationships with all employees and clients.
· Knowledge of CPT-4 and ICD-10 coding.
· Knowledge of Allscripts Misys/Tiger, Allscripts Pro PM, and Practice Insight preferred.
· Ability to professionally communicate effectively orally and in writing.
CERTIFICATIONS / LICENSURES / CREDENTIALS: None
SUPERVISORY RESPONSIBILITIES: Yes
The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position requires full range of body motion including manual and finger dexterity and eye-hand coordination. The position additionally requires standing/sitting for extensive periods of time. Occasional lifting and carrying items weighing up to forty (40) pounds may be required. Requires corrected vision and hearing to normal range.
The work environment characteristics described are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment involving frequent interaction with staff, clients and the general public.