Robert Young Center - CADS, Manager of Business and Billing Operations

Overview

Description of Position:

Responsible for the overall management and coordination for both the Robert Young Center (RYC) and Center for Alcohol & Drug Services (CADS) Revenue Cycle and Payee Services staff.  This includes responsibility of the chargemaster and coding, posting analysis, state reporting, payee services, payor contract analysis, development and informatics for Electronic Medical Records (EMR).  Ensures that the system is in compliance with all outside licensing, regulatory and accrediting bodies, DMH Mental Health Code, HIPPA and third-party payors.  Attends and participates in all divisional meetings, hospital meetings and other committees/meetings, as appropriate.  Must have interpersonal skills necessary to deal effectively with staff, the public, medical staff and other hospital personnel.

Responsibilities

Essential Functions/Responsibilities:

% of Time

(annually)

Service Quality Indicators

·       Develop and work with RYC VisionWorks lead to implement changes to VisionWorks EMR and other systems for financial and administrative capabilities, efficiencies and interoperability.  Working with other leaders and medical providers for process improvement and regulatory compliance. 

·       Oversees the Revenue Cycle for RYC & CADS and works with both UPH TRHS and corporate Centralized Billing Office (CBO) on initiatives for process improvement.

·       Comprehensive understanding and oversight of the chargemaster for compliance with applicable rules and regulations and appropriate assignment of CPT/HCPCS codes and charges for procedures/services provided, to include various regulations on methodologies for service (e.g., telepsych and health home services).

·       Works closely with Payor Contracting and Credentialling to ensure UPH payor strategies and financial goals are achieved.  Acts as Behavioral Health Revenue Cycle liaison for regional and local payors, facilitating accurate and timely payment methodologies for TRHS.

·       Ensures all HIPPA, state and federal regulatory requirements are met with medical records and distribution.  Investigates and resolves compliance issues or violations.  Works with Risk Management to mitigate legal findings.

·       Oversees quality and financial regulatory requirements for Payee Program to include periodic audits and inspections from the state.

65 %

Resource and Revenue Enhancement

·       Understands all aspects of revenue generation for areas of responsibility.

·       Monitors charges to assure all charges are entered accurately and in a timely manner.

·       Assures staff is properly trained to identify and enter all charges for services delivered.

·       Identifies and recommends opportunities for improvement in revenue production and cost reduction.

15%

Talent Development

·       Responsible in employment, evaluation, coaching, discipline, termination and education of personnel

·       Provide consistent direct and indirect supervision to all staff within assigned departments

·       Assist in the development and implementation of a training program to meet the needs of staff

·       Provides specific and timely feedback to employees to improve performance

10%

Basic UPH Performance Criteria        

·       Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.

·       Demonstrates ability to meet business needs of department with regular, reliable attendance.

·       Employee maintains current licenses and/or certifications required for the position.

·       Practices and reflects knowledge of HIPAA, Joint Commission, CARF, OSHA and other federal/state regulatory agencies guiding healthcare.

·       Completes all annual education and competency requirements within the calendar year.

·       Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse.  Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff.  Takes appropriate action on concerns reported by department staff related to compliance.

10%

Disclaimer: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that required of the employee.  Other duties, responsibilities and activities may change or be assigned at any time with or without notice.

Qualifications

Minimum Requirements

Education:

Minimum of a Bachelor’s Degree required. 

Experience:

Five years’ experience in a healthcare related setting, health information management or business setting.  Data analysis skills.

License(s)/Certification(s):

Knowledge/Skills/Abilities:

·       Considerable knowledge of informatics and EMR systems.

·       Knowledge of audits and reimbursement regulations

·       Knowledge of performance improvement practices

·       Ability to effectively supervise and direct other staff members

·       Knowledge of Illinois Mental Health Code, 42 CFR Part 2, Joint Commission and CARF accreditation requirements

·       Must have considerable knowledge of substance use disorder prevention services.

·       Knowledge of clinical education requirements, standards, and practices

·       Communicate effectively, orally and in writing.

·       Knowledge and skill in computer word processing application

Other:

Use of usual and customary equipment used to perform essential functions of the position.