Management
85500 - Credit & Collection
Full-Time
Days
8 Hour
0800
Description
| Under general direction of the Director, Revenue Cycle, the Manager, Patient Accounts manages the claim creation, billing and collection processes of his/her department. Responsible for the development, implementation and monitoring of a program to ensure that claims are paid accurately and timely. This position manages the day-to-day activities of his/her department in accordance with departmental and Hospital guidelines. |
Core Competencies |
- Ensures selection, training, orientation and assignments of department staff; develops standards of performance and monitors and manages staff; evaluates performance and initiates or makes recommendations for personnel actions, promotions and disciplinary action; encourages professional development through in-service education; develops and maintains job description for all staff members; resolves staff grievances.
- Maintains personnel records; approves CTO; and prepares work schedules for employees to provide adequate coverage for completion of required duties.
- Mediates staff conflicts and problems; documents and counsels performance problems; and promotes teamwork.
- Acts as a role model verbally and behaviorally.
- Attends meetings, as required, and participates in committees, as directed
- Acts as a liaison for the department with other Hospital departments, physicians, payors, patients, and patients' family members.
- Participates in Finance Division Hoshin goals by assisting the Director, Revenue Cycle in establishing goals for the department; and assists staff in setting goals and meeting standards.
- Uses KPIs to manage and monitor revenue cycle operations, such as cash collections.
- Performs duties of department staff, as needed.
- Utilizes an effective internal tracking and documentation process to retain communications with and information received from Government entities that includes CMS, Fiscal Intermediaries, Carriers, and the OIG
- Participates in hospital performance improvement activities.
- Utilizes hospital computer system to update, adjust, and process accurate patient accounts.
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Department Specific Competencies |
- Develops, maintains and updates department policies and procedures; and develops and maintains training materials.
- Assists in developing, implementing and coordinating a Denial Management process to improve denial outcomes; gathers information that will correct the denial and prevent future denials; and monitors regulations to ensure practices are current.
- Educates management and office staff regarding the way in which claims are paid.
- Works and assists staff in resolution of problem accounts.
- Performs claims audits periodically to ensure that claims are paid accurately.
- Monitors expenditures to ensure efficient use of resources to maintain budget.
- Ensures equipment meets specifications to maximize productivity.
- Assists in Disaster Drills, as needed, and follows Disaster protocols in the event of an emergency.
- Monitors work queues to ensure that claims are being processed timely.
- Maintains and follows-up on claims in medical review, claims holding various edit issues.
- Serves as the point person for true Self-Pay, non-capitates PPO/HMO and other commercial insurance patient accounts.
- Maintains the insurance master in Patient Accounting system.
- Maintains advanced knowledge of commercial payer requirements.
- Oversees the client billing process.
- Oversees the uninsured/underinsured allowance process.
- Attends meetings with outside providers/vendors regarding Revenue Cycle functions and processing of claims.
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Education |
| Degree | Program |
| High School Diploma/GED or Higher Education | General Studies |
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Experience |
| Number of Years Experience | Type of Experience |
| 5 | Billing and collection of PPO and HMO accounts |
Additional Information |
| Three or more years of supervisory experience in an acute care hospital with experience in admitting procedures/requirements, insurance billing procedures and requirements, patient accounting and collection procedures and electronic remittance advice and payment posting requirements. |
Compensation Range $82,000 - $133,000 / Annually |
