Plans, organizes, controls,standardizes and directs UH CBO Insurance collections employees, processes andstrategy. Manages day to day operations of the Revenue Cycle billed AR toensure the efficient and expected cash collection through productive and timelyclaim submission, follow-up, denials management and appeal activity toensure expected payment of insuranceand/or patient claims for all hospital services billed through the CentralBusiness Office. Remains current forself and staff with governmental and third party billing, follow-up and appealrequirements for compliant billing and follow-up of both inpatient andoutpatient claims for all wholly owned facilities. Performs departmental auditreview and resolution processes in accordance with organizational requirementsfor areas of responsibility. Worksclosely to support RCM Senior leadership to coordinate support and hand offsbetween Pre-billing/billing, Hospital Financial Counselors, Customer Service,Self-Pay Collections and Physician A/R teams to optimize patient experience andcollections. Leadership roleresponsible for managing secondary billing office vendor relationships andperformance designed to optimize net revenue. Works closely with Managed Care, Payers,Finance and Operations to communicate A/R performance and resolve A/R issuesand drive process improvement.
Theposition is responsible for an estimated 70 to 80 FTEs, including 4 supervisorsand annual hospital insurance collections of over $1.8B.
Establishes,enforces and ensures standards of performance and behaviors, monitors andanalyzes departmental service standards for Insurance Follow up Insurancecollections, and responds timely with Customer Service to respond to in-boundpatient call activity to ensure our patients receive superior service.
Theposition is responsible for adhering and creating Insurance Collection policyand guidelines in coordination with RCM Senior Leadership, as well as driving insurancecollection strategy, analysis, monitoring payor performance, as well asoversight of Denials, Credit Management and Post Payment Review. Supports in decisions and strategy associatedwith on line and other technology solutions as well as pre collect, collectionand other vendors contracted to optimize patient collections. Ongoing alignment and strategy to coordinateand follow processes implemented by CBO.
Understandsand supports internal and external relationships including I.T., Legal,Compliance, Internal Audit as well as vendor relationships to ensure compliantrevenue transactions for each of the 7 Core Hospitals (Case, UH Regional,Ahuja, Geauga, Geneva and Conneaut)
Directlyoversees multiple supervisors and 70+ staff members, and isresponsible for ensuring staff work quality and output is satisfactory andissues addressed and/or resolved. Responsiblefor all hiring and related personnel decisions, completing routine performancereview evaluations, training, scheduling, and process documentation.
Responsiblefor cash collections of approximately $1.8 billion.
Reviews,sets and communicates department productivity standards and AR goals for theteam. Ensures Supervisors and staff members are meeting quality andproductivity standards by performing/reviewing routine audits. This also includes conducting routine staffaudits for productivity and tracking results.
Provides month-end AR reports to leadership on active AR dollars.
Maintainsin-depth knowledge of system software including primary financial systems,claims systems, and cash posting systems.
Providesextensive customer support service, acts as a liaison for both internal andexternal customers providing assistance in claims submission and resolution. Resolvesescalated patient complaints.
Generates and analyzes reports for AR review and resolution to include root cause definitions.
Generates, monitors, analyses and reviews reports to assist with Post-Pay issues and resolution resulting in additional cash recovery acting as primary liaison for all departments and external agencies.
Generates, monitors, analyses and reviews Denial management reports to assist with issue and trend resolution resulting in additional cash recovery acting as primary liaison for all departments and external agencies.
Acts as primary contact meeting with SBO administrators on a regular basis, leads assignments and process improvement, and monitors SBO inventories to ensure timely resolution of accounts.
Acts as primary liaison with UH Legal and addresses any claims related to risk issues to resolve balances.
Acts as primary contact for outside discount agencies working on behalf of commercial carriers looking for reductions on UH Claims, manages communications and individual LOA's that are claim specific.
Participates/leads in payer, departmental and Hospital specific AR task force meetings.
Responsible for providing feedback suggestions and process improvement recommendations to leadership. Identifies opportunities for process improvement by recognizing issues based on delayed billing or payments. Provides timely feedback to peers in operational areas and leadership to improve Revenue cycle processes. Participates in process improvement initiatives throughout the entire revenue cycle operation.
Initiates and leads special projects.
Responsible for maintaining relationships with external vendors and third party payers regarding claim/contracting issues to maximize reimbursement for the Health System.
Plans, develops and monitors department operating budget.
Maintains in-depth knowledge of policies, procedures and laws relating to medical insurance company billing. Ensures departmental compliance.
Identifies billing errors, and follows-up with staff members/third party payers to ensure resolution.
Identifies trends with third party payers, and coordinates and implements changes for improved billing methods.
Analyzesand resolves claims; contacts patient, guarantors, and/or third-partyorganizations to secure information as needed; prepares and maintains patientbilling records to assist in the adjudication of difficult claims.
Overseesand assists supervisors with orientation and training in Revenue Cycle Policiesfor billing and follow-up to ensure maximum reimbursement for CBO.
*This role mayencounter Protected Health Information (PHI) as part of regularresponsibilities. UH employees mustabide by all requirements to safely and securely maintain PHI for our patients. Annual training, the UH Code of Conduct andUH policies and procedures are in place to address appropriate use of PHI inthe workplace
Experience & Knowledge:
Minimum 5 years of progressive experience in healthcare revenue cycle operations required.
Minimum 2 years supervisory experience required, which includes experience hiring, training, evaluating, disciplining, developing and engaging staff members required.
Must have working knowledge of claim submission, (UB04/1500) and third party payors.
o Knowledge ofFederal Billing Regulations required.
o Must bedetail-oriented and organized, with good analytical and problem solvingability.
o Notable clientservice, communication, presentation and relationship building skills required.
o Ability to function independentlyand as a team player in a fast-paced environment required.
Must have strong written and verbal communication skills.
Special Skills & Equipment Knowledge:
Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, FAX machine, etc.) required.
Oracle, Kronos, Soarian, and/or IDX experience preferred.
Equal Opportunity Employer – minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity