SCOPE / GENERAL PURPOSE OF JOB:
Responsible for managing the daily functions of the Cash Applications department in accordance with RC Billing’s standards and Reimbursement policy and procedures. Directly supervises cash applications to ensure timely and accurate posting, generates weekly and monthly reports and ensures their accuracy; solves problems and improves efficiency to the business office operations while ensuring benchmarks are obtained per client and ensuring client satisfaction.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Directs the daily operations of the cash application department to ensure accuracy and timeliness.
- 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.
- Ensures daily accurate and timely (within 2 business days of receipt) line item posting of all receipts received from payors to include the appropriate contractual adjustments, filing of secondary’s, accurate release to patient responsibility, etc…
- Ensures daily accurate and timely (within 2 business days of receipt) line item posting of denials/zero payments received from the payors, to include posting the appropriate denial reason.
- Ensures daily and timely (within 2 business days of receipt) accurate line item posting of approved adjustments received from AR, to include client approval when required.
- Ensures timely daily resolution of any unidentified receipts (unable to identify the patient account/line item to accurately post)
- Ensures timely recognition of client ERA issues and works directly with RC Billing Support, EDI Depts., Credentialing & Contracting Dept., and Waystar/Practice Insight for immediate resolution.
- Ensures that a Daily Receipt Log for each client is maintained daily, balanced and accurate for weekly reporting to each client.
- Ensures that clients receive accurate and timely weekly reports.
- Schedules by the 2nd business day of each month and directly oversees month-end system closes; ensures that all areas meet cutoff and ensures client monthly reporting packages are generated within 2 – 3 days of close and disseminated accordingly to the clients.
- Works directly with client banking and client to ensure timely receipt of lockbox and/or seeks resolution to any issues relating to a client’s deposit.
- Ensures that processes are in place to identify payments received are in accordance with the clients contracted fee schedules.
- Works in conjunction with the President of RCB with new client go lives.
- Works directly with clients and client preferred banking to assist the client in establishing and setting up new lockbox services.
- Oversees daily communication between CBO team and client practices.
- Communicates with clients as necessary, not less than monthly, to include physicians, administration and business departments. Schedules and participates in monthly conference calls with clients to discuss the prior month’s financials, issues identified, issues resolved, etc.
- Implements and ensures compliance with RC Billing Reimbursement Policies and Procedures to maximize efficiency. Ensures compliance with appropriate industry regulations and State and Federal regulations.
- Ensures computer master parameters including CPT-4 and ICD-10 code files, fee schedules, insurance, physician, etc. are accurate. Works with the EDI Dept. for updates and file maintenance.
- Supervises business office staff; assists with developing and attaining performance goals and objectives. Evaluates performance and recommends merit increases, promotions, and disciplinary actions.
- Ensures that all applicable cash application dept. policy and procedures are current and policies are updated with any warranted changes and sent to the President for final approval then implements with the cash application dept. staff.
- Maintains working day to day knowledge of the practice management system.
- Maintains working knowledge of applicable laws and regulations as they relate to assigned responsibilities.
- Maintains working knowledge of Medical and Radiation Oncology billing guidelines.
- Maintains confidentiality of all information related to patients, medical staff, finances and cost effective health care delivery issues.
- Strives to achieve and maintain company Days Sales Outstanding, Account Receivable Aging standards and Collection Percentages per client.
- Assists in the development of and primary responsibility for maintaining productivity standards relating to Cash Application, Accounts Receivable resolution, Claim Submission and other related CBO tasks.
- Training of reporting employees of areas as assignment through job focus.
- Other duties as assigned.
EDUCATION AND/OR EXPERIENCE:
- High school diploma or equivalent, Bachelor’s degree preferred.
- Minimum seven (7) years medical office management experience.
CERTIFICATIONS / LICENSURES / CREDENTIALS: None
- 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 CPT-4 and ICD-9/ICD-10 coding.
- Knowledge of Allscripts, Allscripts Pro PM, Misys/Tiger and Practice EDI Insight preferred.
- Ability to communicate effectively orally and in writing.
SUPERVISORY RESPONSIBILITIES: Yes
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.
The work environment characteristics described 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 involving frequent interaction with staff, clients and the general public.