Senior Manager-Professional Billing Org (PBO)
Newark , NJ, USA | Stanford Health Care hospital
Industry:Healthcare - Hospitals
Functions:Accounting / Control
Job Description:78 people have viewed this job
Under the general direction of Revenue Cycle leadership, provides organization direction for Professional Billing to ensure timely billing, collection and cash posting of all physician charges from all payors. The Senior Manager assists the Director in establishing the organizational priorities and operational strategies to drive optimal performance of the Professional Revenue Cycle. The PBO Senior Manager acts as a liaison between clinic operations leadership and other departments in the organization.This position provides assistance to the Director to ensure that the organization is performing and delivering against the agreed upon service levels in the organization. The Senior Manager is responsible for the department’s overall cash, accounts receivables and write-offs performance.
The Senior Manager must have a clear understanding of the overall organization and the “clients” that the PBO Revenue Cycle serves. To effectively lead the department, the senior manager must have a strong working knowledge of the operational details, process issues, barriers and opportunities and must possess the creativity motivation to drive change, realizing maximized reimbursement and minimized financial risk to Stanford Health Care. Successful oversight will result in increased net revenue and lower cost to collect. Interactions will primarily be conducted with both clinics and payors and results of efforts will drive actions to secure payment for all claims sent to payors.The Senior Manager serves as a resource to faculty, managers, department and clinic staff in all professional revenue cycle related issues.
The essential functions listed are typical examples of work performed by positions in this job classification and are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities.Specific duties and responsibilities may vary depending on department or program needs without changing the general nature and scope of the job or level of responsibility.Employees may also perform other duties as assigned.
Employees must abide by all Joint Commission requirements including, but not limited to, sensitivity to cultural diversity, patient care, patients’ rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.
Employee must perform all duties and responsibilities in accordance with the C-I-CARE Standards of the Hospital. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions.
Performs Job duties assigned in one or more of the following areas:
Management and Leadership
Provide leadership, direction and guidance; Set departmental goals and priorities and assign management oversight for the daily office operations.
Monitor daily operating activity of department; conduct daily huddles with staff to review department performance and goals and make necessary adjustments in work assignments
Manage the performance and work products/services of staff.
Direct managers in developing and implementing short- and long-term work assignments and objectives for staff. Develop guidelines for prioritizing work activities, evaluating effectiveness, and modifying activities as necessary.
Review and drive improvements in Revenue Cycle ensuring financial obligations are met in accordance with SHC policies and procedures.
Utilize feedback and needs assessment tools to understand internal customer expectations.
Strive to provide service that exceed expectations and work to eliminate barriers to good service. Maintain relationships with all internal applicable parties, third party payers, and other agencies, as appropriate.
Serve as a liaison to key department and clinic contacts to ensure that the PBO is meeting service levels and to address issues that may cause challenges to meet service levels and KPIs.
Work collaboratively with clinic operations and other departments to drive organizational efficiencies and alignment and to ensure processes and systems are standardized and optimized for efficient and effective flow of accounts within the department and the organization.
Maintain a complete record of current policies and procedures followed by staff in department; Responsible for maintaining complete knowledge of the revenue cycle and patient flow including steps taken by staff to complete these procedures; assists supervisors in understanding/implementing and adhering to department and organization policies and procedures
Identify areas of opportunity to apply process changes and/or technology implementation/updates to optimize PBO performance.
Manage implementation of standards and systems to enhance quality, consistency, efficiency, and timeliness of responsibilities for the enterprise; designing, develop, and monitor performance improvement processes (e.g. quality, accuracy, productivity and timeliness); identify continuous improvement opportunities and manage productivity metrics and efficiencies
Represent the department on various committees and attend administrative meetings committees as requested.
Participate in professional development activities and maintain professional affiliations.
Identify revenue cycle issues and provide leadership for root cause analysis and problem resolution.
Maintain detailed understanding of all systems including electronic health record, physician billing systems and other business systems including system functionality, workflows, and reporting; proactively identify areas for improvement and engage with Information Technology and Revenue Cycle leadership to make necessary changes.
Manage multiple projects in a timely and efficient manner.
Conduct special projects and studies as directed; perform other related and incidental duties as needed or assigned.
Staffing and Development
Ensure that functional areas of responsibility are staffed appropriately, assist in organizational changes and planning as necessary
Interview, select, hire and maintain competent and performing staff
Assure that management is adequately supported, trained and consistently meets competency requirements and levels Supervise, train, orient, coach, develop and evaluate performance over assigned personnel; initiate corrective actions to improve performance deliverables and/or resolve issues as they arise, recommend promotions or implement corrective/disciplinary actions as necessary.
Foster a success-oriented, accountable environment
Participate in regular huddles throughout the PBO
Conduct regular unit staff meetings;
Conduct and report on monthly productivity/quality assurance audits.
Encourage ongoing staff development and growth. Develop individual staff goals and training plans.
Ensure that personnel management is handled timely including evaluations, issue resolution, employee labor relations involvement and disciplinary action. Serve as escalation contact as appropriate.
Through leadership and by example, ensures that services are provided in accordance with state and federal regulations, organizational policy, and accreditation/compliance requirements.
Keeps up-to-date on all regulatory and accrediting agency requirements, including Federal and State regulations and Joint Commission standards as they relate to billing, follow-up, remit posting and payment variance. Ensures compliance with policies and directives issued by Medicare, Medicaid, Third Party Payers, and others as needed.
Maintains knowledge of and complies with established policies and procedures including government, insurance and third-party payor regulations.
Assures compliance with the medical staff bylaws, rules and regulations, and hospital and departmental policies and procedures.
Ensure adherence to all aspects of state, local, and federal Billing Compliance policies
Maintain and enforce patient / client / employee confidentiality
Provide overall direction and supervision to the billing, follow-up, collection, and resolution of all payor accounts; direct the day-to-day activities of insurance claim editing and billing, insurance follow-up, denial and appeals
Serve as a contact/resource to other departments and clinics for information on payor guidelines, policies and procedures; updates staff and outside departments on government (Medi-Cal/Medicaid/Medicare/VA) regulations and non-government payor medical and billing policies.
Serve as escalation point to external stakeholders related to billing, follow-up, cash posting, payment variance and/or provider enrollment;
Ensure that workflows are operating optimally to meet organizational KPIs and ensure timely reimbursement with minimal revenue leakage; monitor backlogs, identify root cause and implement corrective measures as necessary.
Review current status of patient accounts to identify and resolve billing and processing problems in a timely manner.
Set goals and implement measurement and tracking to ensure goals are met for delinquent AR, cash collections, denials and controllable write-offs
Solve difficult payment and associated payor problems (e.g. denials). Audit problem accounts.
Monitor charge or payor patterns or trends in payment variance and communicate to external stakeholders as necessary
Provide regular updates to external stakeholders and Revenue Cycle leadership on payor variance and net revenue performance
Ensure that cash posting processes meet treasury and accounting practices and policies; support audit activities as necessary
Maintain working knowledge of the Epic payment posting system and perform ongoing training to staff as needed.
Understand enrollment functions that support appropriate payer contracting and claims adjudication
Support physicians and clinics to ensure that all professional revenue can be billed and paid by payors
Work closely with Providers, Clinic Operations and Revenue Cycle leadership to address issues and problems related to provider enrollment (e.g. enrollment constraints); Proactively communicate Provider Enrollment issues to providers and impacted clinics.
Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.
Education: Bachelor's degree from an accredited college or university.
Experience: Five (5) years of progressively responsible and directly related work experience.
Knowledge, Skills and Abilities
These are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education, or licensure/certification.
Excellent verbal and written communication skills, including effective reporting of operations, issues and performance.
Excellent people skills, with an ability to partner with a dynamic leadership team and navigate enterprise politics and matrixed relationships.
Demonstrated experience as a team leader; leading teams to generate a vision, establish direction and motivate members to achieve established goals.
Skill in planning, organizing, delegating, and supervising.
Skill in evaluating the effectiveness of existing methods and procedures.
Skill in problem solving.
Ability to manage in complex environment.
Ability to develop long-range business plans and strategies.
Ability to foster effective working relationships and build consensus.
Ability to mediate and resolve complex problems and issues.
Ability to provide leadership and influence others.
Ability to recognize and analyze the impact of regulatory changes on the financial performance of professional revenue.
Ability to read, interpret, and apply policies and procedures.
Ability to set priorities among multiple requests.
Ability to interact with patients, medical and administrative staff, and the public effectively. Knowledge of accounts receivables and reimbursement management.
Knowledge of CPT, ICD10 coding and medical terminology.
Knowledge of government program regulations and compliance requirements as they relate accounts receivable management.
Knowledge of information system and software relating to accounts receivables management and billing; Knowledge with EMR and practice management systems. Epic Certification a plus.
Knowledge of local, state and federal regulatory requirement related to the functional area.
Knowledge of principles and practices of organization, administration, fiscal and personnel management.
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