SCOPE / GENERAL PURPOSE OF JOB:
Responsible for supervising the day to day functions of the AR and Patient Services Department per assigned client in accordance with RC Billing standards and Reimbursement policy and procedures. Responsible for timely submission of all adjustments; directly supervises accounts receivable to ensure timeliness, accuracy and productivity; assists with generation of monthly reports and ensures their accuracy; communicates a minimum of monthly with assigned clients regarding their financials; solves problems and improves efficiency within the AR Department operations while ensuring the lowest possible accounts receivable is maintained, the lowest possible DSO and ensuring client satisfaction.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Supervises the daily operation of the AR and Patient Services Department to ensure accuracy and timeliness of AR resolution for all assigned clients, i.e. patient AR and insurance AR
- Ensures that daily, weekly, and monthly AR functions are performed and accurate to include successful claim submissions, resolution to EDI reports, claim status, etc…
- Ensures that patient collections policy and procedure is followed for all assigned clients and the timely submission of accounts to clients for directive. Ensures timely follow up with clients once submitted for status.
- Assists with new hire orientation applicable to the department while ensuring assigned AR staff are properly trained to perform their job; RCB policy and procedures, Misys Tiger, Practice Insight, Remit Data, CCL, Radiation Coding, etc…
- Will perform specific aspects of AR training personally while other aspects may be performed by appropriate staff members.
- Directly responsible for the timely review and approval of Refunds, Adjustments and Charge Corrections.
- Directly responsible for the submission of client directives and the timely follow up with clients to obtain the signed directive.
- Responsible for assisting the AR Manager with International Patient invoicing and follow up for payment
- Works in conjunction with the AR Manager to ensure AR’s are being reviewed at a minimum of monthly to ensure timely and appropriate actions are taking place by the AR Specialist for resolution.
- Works in conjunction with the AR Manager to complete quarterly QA’s for each AR Specialist direct report.
- Assist the AR Manager in preparation for the client monthly financial calls and participates in the conference call.
- Assist the AR Manager in completing AR Specialist performance evaluations.
- Demonstrates thorough understanding of and oversees all aspects of monitoring and interpreting insurance reimbursements and implementing procedures that ensure optimum collection in a manner compliant with Federal and State regulations and RC Billing policy and procedures.
- Works in tandem with the management team to perform timely month-end close for all clients.
- Monitors aged accounts receivable for insurance responsible amounts; ensures that the proper processes are followed and ensures that agings are maintained within RC Billing standards.
- Assist with monthly AR work plan per client, disseminates to staff, follows through to ensure accurate and timely AR resolution is sought to the plan and the volume of accounts are worked in accordance with the AR P&P.
- Participates in meetings with Accounts Receivable Manager and direct reports regarding status of their AR work plan and compliance with daily expectations per policy at a minimum of once per month.
- Assist Accounts Receivable Manager with monthly financial analysis on accounts receivable, collection percentages, billing statistics, etc. for reporting and discussion with the VP of RC Billing.
- Oversees daily communication between CBO Insurance AR team and client practices (where approved).
- Communicates with client as necessary. Participates with monthly conference calls with clients to discuss the prior month’s financials, issues identified, issues resolved, etc.
- Ensures compliance with RC Billing Reimbursement Policies and Procedures to maximize efficiency. Ensures compliance with appropriate industry regulations and State and Federal regulations.
- Identifies and recommends to Accounts Receivable Manager any need for additional documented policy and procedures. Ensures strong communication and working relationship with the CBO Management team and VP.
- Assist with the evaluation of AR staffs performance.
- Maintains strong working knowledge of Radiation Oncology billing and coding guidelines.
- Maintains strong working day to day knowledge of the practice management systems. i.e. Misys/Tiger, Allscripts, Allscripts Pro PM and Practice EDI Insight.
- Maintains strong working day to day knowledge of the denial management system/Remit Data.
- Maintains strong working knowledge of applicable laws and regulations as they relate to assigned responsibilities.
- Maintains confidentiality of all information related to clients, patients, medical staff, finances and cost effective health care delivery issues.
- Maintains confidentiality at all times of management meetings and discussions.
- Strives to achieve and maintain company Days Sales Outstanding and Account Receivable aging standards.
- Responsible for maintaining productivity standards relating to Accounts Receivable resolution.
- All other Duties as Assigned
EDUCATION AND/OR EXPERIENCE:
- High school diploma or equivalent Bachelor’s degree preferred.
- Minimum three (3) years medical office management experience.
- Knowledge of fiscal management and human resources management practices.
- Knowledge of organization policies and procedures.
- Knowledge of health care administration principals.
- Knowledge of business office procedures.
- Previous supervisory experience required.
- Knowledge of insurance agency operating procedures and practices.
- Skill in exercising initiative, judgment, discretion and decision -making to achieve business unit objectives.
- Skill in identifying and resolving problems.
- Ability to communicate effectively regarding fiscal policies.
- Ability to establish and maintain effective working relationships with all employees and clients.
- Knowledge of Allscripts, Allscripts Pro PM, Misys/Tiger and Practice EDI Insight are preferred.
- Knowledge of CPT-4 and ICD-9/ICD-10 coding.
- Ability to communicate effectively orally and in writing.
The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position requires full range of body motion including manual and finger dexterity and eye-hand coordination. The position additionally requires standing/sitting for extensive periods of time. Occasional lifting and carrying items weighing up to forty (40) pounds may be required. Requires corrected vision and hearing to normal range. Ability to travel; will be required 20% annually
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment. Involves frequent interaction with staff, clients, patients and the general public