Manager Revenue Cycle Professional Billing
Under general direction of the Texas Health Physicians Group (THPG) PBO Director, the PBO Rev Cycle Manager is responsible for overseeing revenue cycle activities to ensure consistent fiscal performance and achievement of specific departmental standards and goals.
The Manager oversees the supervisory staff to ensure stated goals are met through the following processes: claim submission, credit balance resolution, payor follow up, denial review, appeal submission and adjudication. The manager is also responsible for monitoring and improving all revenue cycle metrics and measures, including but not limited to the following: AR days, aged AR, cash collections, denials, avoidable write-offs, staff productivity and work quality.
All responsibilities are performed in accordance with established organizational policies, procedures and compliance and quality standards.
Work Location: This position can be remote for candidates living in states that have been approved for remote work location.
Job Duties
People:
- Responsible for the direction and coordination of several centralized business office operations related to the processing and adjudication of professional claims to insurance.
- Manages all essential revenue cycle team functions. Effectively leads and develops a team of employees including training.
- Ensures all revenue cycle team staff are current in competencies, assessments, licensure, certifications, and other annual training.
- Ensures work environment complies with regulatory, licensure, compliance, and accreditation requirements by monitoring the work setting on an ongoing basis to identify deficiencies, risk and opportunities for improvement.
- Participates in and completes all required employee training, including recurring and ad-hoc education sessions.
- Enforces and monitors corrective action plans.
Quality:
- Manages revenue cycle operations to resolve claim, denial, payment issues and implements risk mitigation and resolution strategies.
- Implements and manages performance goals and objectives as well as long-term performance planning.
- Reports all confirmed or suspected privacy breaches, concerns regarding privacy to the Entity Safety Office or Compliance in a timely manner.
- Assists with training, auditing of work, and provides feedback to Supervisors or Team Leads on opportunities for improvement. Ensures productivity goals, metric benchmarks, and quality standards are consistently met by all team members.
- Regularly reports out to PBO Director and other entities as necessary regarding department metric performance, risk, achievements, and resolution strategies.
- Demonstrates strong technical skills to review and evaluate trending metric data for root-cause analysis.
- Regularly monitors appropriate metric dashboards and addresses technical issues and user education opportunities, as appropriate.
Service:
- Serves as first point of contact for complaints related to revenue cycle team operational concerns and feedback. Responsible for investigating all complaints related to revenue cycle team operations and routes privacy and/or compliance complaints/issues. Escalates problems as needed.
- Attends and engages in all applicable meetings, committees, and work groups to communicate revenue cycle updates and resolve process issues. Acts as a liaison between the revenue cycle team and key department stakeholders including Operations, Coding and Reimbursement, Patient Access, vendors and executive leadership.
- Helps resolve more complex and/or escalated billing, insurance follow-up, and credit inquiries and problems, handing follow-up questions and resolving user discrepancies or errors.
Financial:
- Coordinates scheduling of operations to ensure proper coverage of account completion and out-of-office calls.
- Conduct follow-up on identified discrepancy and root-cause analysis to prevent systematic recurrence of quality issues.
- Interprets and/or evaluates information and/or creates analytical approaches.
- Analyzes operations to identify problematic activity impacting AR aging, denials, and write-offs for departments and providers.
- Initiates revenue acceleration projects and special projects as a result of ongoing analysis.
Growth:
- Consistently organizes, evaluates, and executes on strategies to improve department performance metrics through Epic based reporting packages.
- Develops new ideas resulting in major improvements to existing methods, services, processes and/or procedures.
- Seeks new and creative technologies that help identify and guide improvement opportunities that align with overall PBO success.
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