Manager, PPO

Core Competencies

• Ensures selection, training, orientation and assignments of department staff; develops standards of performance and monitors and manages staff; evaluates performance and initiates or makes recommendations for personnel actions, promotions and disciplinary action; encourages professional development through in-service education; develops and maintains job description for all staff members; resolves staff grievances.
  
  
• Maintains personnel records; approves CTO; and prepares work schedules for employees to provide adequate coverage for completion of required duties.
  
  
  
• Mediates staff conflicts and problems; documents and counsels performance problems; and promotes teamwork.
  
  
• Acts as a role model verbally and behaviorally.
  
  
• Attends meetings, as required, and participates in committees, as directed
  
  
• Acts as a liaison for the department with other Hospital departments, physicians, payors, patients, and patients' family members.
  
  
• Participates in Finance Division Hoshin goals by assisting the Director, Revenue Cycle in establishing goals for the department; and assists staff in setting goals and meeting standards.
  
  
• Uses KPIs to manage and monitor revenue cycle operations, such as cash collections.
  
  
• Performs duties of department staff, as needed.
  
  
• Utilizes an effective internal tracking and documentation process to retain communications with and information received from Government entities that includes CMS, Fiscal Intermediaries, Carriers, and the OIG
  
  
• Participates in hospital performance improvement activities.
  
  
• Utilizes hospital computer system to update, adjust, and process accurate patient accounts.
  
  

Department Specific Competencies

• Develops, maintains and updates department policies and procedures; and develops and maintains training materials.
  
  
• Assists in developing, implementing and coordinating a Denial Management process to improve denial outcomes; gathers information that will correct the denial and prevent future denials; and monitors regulations to ensure practices are current.
  
  
• Educates management and office staff regarding the way in which claims are paid.
  
  
• Works and assists staff in resolution of problem accounts.
  
  
• Performs claims audits periodically to ensure that claims are paid accurately.
  
  
• Monitors expenditures to ensure efficient use of resources to maintain budget.
  
  
• Ensures equipment meets specifications to maximize productivity.
  
  
• Assists in Disaster Drills, as needed, and follows Disaster protocols in the event of an emergency.
  
  
• Monitors work queues to ensure that claims are being processed timely.
  
  
• Maintains and follows-up on claims in medical review, claims holding various edit issues.
  
  
• Serves as the point person for true Self-Pay, non-capitates PPO/HMO and other commercial insurance patient accounts.
  
  
• Maintains the insurance master in Patient Accounting system.
  
  
• Maintains advanced knowledge of commercial payer requirements.
  
  
• Oversees the client billing process.
  
  
• Oversees the uninsured/underinsured allowance process.
  
  
• Attends meetings with outside providers/vendors regarding Revenue Cycle functions and processing of claims.
  
  

Education

Experience

Compensation Range

$82,000 - $133,000 / Annually