- Responsible for data collection, records management and decision support of information and processes within the Reimbursement Department.
- Identify strategies and opportunities to leverage systems, processes, resources and other methods to minimize revenue loss, increase cash flow, and maximize efficiency within the Revenue Cycle.
- Works with corporate and practice management teams to oversee and review collections reports to identify payer and other collections issues. Develops and implements practice specific process improvement recommendations to secure positive results, monitor performance and improvements resolution plans for unfavorable trends.
- Maintains reimbursement related key performance indicators for network practices, setting and benchmarking Revenue Cycle goals i.e. reducing DSO, increasing appropriate charge capture, decreasing outstanding accounts receivable and increasing claim accuracy and cash.
- Participates in the development of the Claims Department Policy and Procedures.
- Identifies problem areas and develops strategy and plan of action to ensure benchmark standards are obtained and maintained.
- Assess revenue cycle performance in accordance with set goals and objectives
- Monitor and research regulatory changes and propose actions to respond to changing legislation/regulations in conjunction with internal and external government relations personnel.
- Evaluate and direct efforts to improve revenue cycle, perform operational reviews of revenue cycle processes and publish recommendations. In conjunction with other department leaders, implements strategic and operational initiatives in Accounts Receivable Management.
- Participate in continual education programs and activities that pertain to healthcare management, as well as specific functional areas
- Generates reports and reviews, daily, weekly, monthly and annual information related to the claim verification, billing, collection and litigated claim functions.
- Participates in future planning, area development, and process improvement to recommend quality and productivity initiatives to improve the efficiency of the departments and exceed customer expectations.
- Demonstrates competency in assigned areas of verification, billing, reimbursements, collections, and litigated claims by completing and approving as necessary annual evaluations of all staff.
- Develops new workflow performance contests and incentive programs for the entire Claims group to create a positive work environment and drive performance.
- Answers incoming calls which have been escalated due to difficulty to determine appropriate action required to achieve resolution.
- Maintains relationships with key carriers and self-insured’s to ensure reimbursement and collection objectives are met.
- Demonstrates active personal, daily involvement with visibility and professionalism to staff, as well as internal and external customers.
- Complies with Human Resource policies and procedures. Strives for competent and satisfied employee group by proper staffing, completing timely performance appraisals, ongoing training, development and mentoring of staff. Hires, coaches, trains, disciplines and terminates staff as necessary.
- Monitors the performance and productivity of the staff and makes procedural or training revisions as required to support the services level and performance goals of the department.
- Produces information and analysis as required in support of the collectability of all types of receivable. Performs specific collectability analysis in support of the annual audit.
- Successfully performs other duties or special projects as assigned.
Bachelor’s Degree with a strong background in managing revenue cycle;
At least 10 years of direct experience in insurance of healthcare reimbursement, collections, billing, and claims verification management.
Extensive experience with a variety of collection practices, and procedures including performance measurement and motivational techniques.
Minimum of 10 years prior work experience in the healthcare or insurance industry with skills in strategic planning, group facilitation, market analysis and hospital/physician relationships
Strong verbal, written and interpersonal communication skills
Strong recruitment skills which facilitate a clear understanding of selection criteria
Strong computer skills, including experience with databases, Windows based applications and A/R related software support systems.
Ability to analyze and assess emerging collection trends and provide strategies for improved collection and, insightful, detail-oriented reporting on those trends.
Ability to deal with external customers enthusiastically and with professionalism.
Ability to effectively present information and respond to questions from both internal and external customers.
Ability to deal with difficult revenue cycle situations and resolve issues delaying/preventing payments from carrier and self-insured’s.