Manager PFS Revenue Cycle

Employee Type:

Work Shift:

Join Team Tidelands and help people live better lives through better health!

Position Summary:
Under the general supervisor of the Revenue Cycle Director, the Revenue Cycle Manager applies professional administrative knowledge and skill while providing accountable oversight of administration and financial systems, processes procedures and projects in the patient financial services area. The primary role is to protect the Accounts Receivable assets of Tidelands Health facilities by oversight for Follow-up, Quality Assurance, Denials Management and AR Analysis and will be responsible for the following:
•    Managing all operational aspects of Tideland Health’s Accounts Receivable (A/R) and relationships while maintaining responsibility for the primary, secondary, and tertiary collections and resolutions of Tidelands Health A/R
•    Attend regularly scheduled web seminars, teleconferences, and training sessions.
•    Work closely with the Managed Care contracting department, monitor updates and train staff to comply with Managed Care contractual arrangements, billing policies and collection guidelines. 
•    Coordinate testing and implementation of new processes/ billing and payer edits required based on changing regulations and billing policies.
•    Coordinate re-billing and adjustments of accounts based on payer responses and hospital and/or physician audits. 
•    Proactive management of Commercial and Managed care accounts receivable. 
•    Develop and maintain relationships with the payer representatives.
•    Work with vendors to resolve ongoing issues and obtain status reports to proactively anticipate and prevent potential issues.
•    Facilitates the timely dissemination of vendor feedback to support improvements related to prospective avoidance.
•    Initiates and follows through on discussions related to required service enhancements and new product/service delivery, as applicable, to support enhanced vendor performance.
•    Manages the day-to-day efforts of people, process, and technology to maintain quality, efficiency and performance among all collectors and denial management representatives.
•    Monitors and maintains all Accounts Receivable system to ensure effectiveness of daily activities, as well as compliance with health system policies and standards.
•    Identifies and develops process improvements to continuously increase accuracy/productivity and improve cycle time; communicate process improvements to management.
•    Manage the coordination and response to payer denials through a workflow process.
•    Collects and analyzes metrics and reports statuses and trends of activities.
•    Reviews, analyzes and reports trends found within EPIC related to disruption of appropriate account flow and/or broken workflow, where opportunities exist for improvement.
•    Works with the IT team members and Revenue Cycle leadership to ensure that issues within EPIC reported are documented, time stamped, and appropriate action is taken to make changes within EPIC or in the various workflows of Revenue Cycle team members.
•    Other duties and projects as assigned.

QUALIFICATIONS

Education:  

Must meet one of the following:

•  High School Diploma with seven (7) years healthcare patient accounting experience required as noted below OR;

•  Associates Degree in Business related field with five (5) years healthcare patient accounting experience required as noted below.  

Experience/Knowledge/Skills:

Significant Five (5) or More Years of Experience with the following:

• Direct management of vendors within a results-oriented PFS department with particular emphasis on collections and billing, both hospital/acute and ambulatory.

• At least three (3) years direct employee management experience.

• Hands-on knowledge of UB-04 and HCFA 1500 billing and account follow up, CPT and ICD-10 coding and terminology for hospital and ambulatory/physician billing, customer service and self-pay functions.

• Strong personal ability to work collaboratively among internal and external departments, to identify and help resolve enterprise-wide challenges.

• Solid understanding of HIPAA transaction sets and compliance with HIPAA privacy laws

• Contract analysis and negotiation.

• Exceptional MS Office suite proficiency (Microsoft Access, Excel, Word, PowerPoint, and Visio)

• Demonstrated experience with having strong interpersonal communication skills required

• Prior experience with interpreting and following detailed policies required

• Demonstrated ability to independently think and make judgments in interpreting and adapting guidelines and making judgment decisions on specific problems required.

• Must pass PC typing test to demonstrate general PC aptitude and keyboarding ability at a minimum of 40 wpm required

• Demonstrated Competency with Microsoft applications such as Outlook, Word, Excel and Explorer required with examples of such work provided required.   

• Demonstrated ability to handle projects and tasks efficiently (time management) required.

• Demonstrated ability to perform highly complex computerized procedural tasked required.

• Working knowledge of best practice, contract management system logic, basic reporting skills, and payor policies and procedures.

• Prior certification course, training program in medical terminology preferred.

• Prior experience with Meditech software program preferred.

Other: 

• In addition, all interactions require an exemplary level of communication skills, leadership skills, teamwork skills, problem solving capabilities, project streamlining and planning abilities, organizational and time management skills. 

• Incumbent should fully support Tideland Health’s Mission and Values.

• Predominantly Day shift M-F position, but management reserves the right to make changes on an as needed basis to meet the needs of the customers and TH programs when such instances arise. May be required to work on holidays and weekends, as necessary

Physical Requirements: Light Physical Agility Test (PAT) Rating

While performing the duties of this job, the employee is frequently (activity or condition exists from 1/3 to 2/3 of the time) required to stand, sit, and walk; frequently to use hands, fingers; and frequently to talk or hear. The employee must exert up to 15 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or up to 5 pounds of force frequently, and/or a negligible amount of force constantly to move objects.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job and post offer Physical Agility test will be required to demonstrate ability to meet minimum physical competencies of the position.

Exposure to diseases possible but not probable due to controlled environment and limited exposure to patients.

Tidelands Health is an equal opportunity employer (EOE). Tidelands Health does not discriminate against employees or applicants for employment on the basis of race, color, creed, religion, age, national origin, disability, marital status, veteran status, gender, genetic information, familial status, or any other legally protected status.