Manager Revenue Cycle A/R Mgmt. - Specialty Billing | Onsite, Full-time days | Sharp HealthCare
San Diego, CA, United States
Hours :
Shift Start Time:
8 AM Shift End Time:
4:30 PM AWS Hours Requirement:
8/40 - 8 Hour Shift Additional Shift Information:
Weekend Requirements:
As Needed On-Call Required:
No Hourly Pay Range (Minimum - Midpoint - Maximum):
$56.418 - $72.797 - $89.176 The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.
What You Will Do
Provides management direction, project development and analysis, implementation planning, process improvements and financial analysis and reporting in the areas of prebilling, billing, follow up, collections, chargemaster guidance and updates as needed, and staff development.
Under the direction of the Vice President Hospital Revenue Cycle, the Manager Revenue Cycle A/R Mgmt. is responsible for all hiring, training, coaching, evaluating, disciplining, and termination of staff in functional unit. The Manager provides overall direction to ensure timely collection of all payers. Identifies issues, monitors performance, and assists in problem resolution.
This position manages department quality and productivity measures while optimizing efficiencies. The Manager is responsible for meeting/exceeding department key performance indicators for Cash Collections, A/R aging, Staff satisfaction and overall A/R days. The Manager prepares assists and adheres to the budgets and financial reports for the functional areas, develops operational plans (short-term and long-term) determines appropriate staffing ratios, evaluates performance, recommends, and implements changes that improve operating efficiencies, prebilling, billing production, cash flow, and reimbursement.
Assists with maintaining workflow modifications that emphasize accuracy, automation, and optimization. Ensures compliance with State and Federal billing regulations. Coordinates all computer conversion activity for responsible area, performs all system testing and quality controls, verifies accuracy and completeness of all mapping criteria, performs ongoing system optimization, and continues implementation of EDI applications. Provides management support to the PFS Trainer/Educator, Payment Processing staff, Shared Service Analyst, Uncompensated Care Specialist, and Hospital Auditors.
The Manager is responsible for coordinating with HB, PB and SBO department Managers/Directors on a regular basis to ensure efficient and effective interdepartmental work processes. PFS Manager acts as a liaison between vendors and hospital departments. The Manager assures employees possess the training and knowledge to competently achieve expected outcomes and performance goals.
The Manager provides leadership to assure that staff practice safe work habits, and that the working environment is consistently within regulatory standards.
Required Qualifications
3 years' experience in large hospital setting, medical group, or A/R consulting company in inpatient accounting.
Preferred Qualifications
Bachelor's degree Business Administration or equivalent knowledge and experience, preferably in accounting or finance.
1-year Epic system experience.
Other Qualification Requirements
Equivalent knowledge and additional years of experience can substitute for a bachelor's degree.
Essential Functions
__QUALITY__
Assures compliance with all Medicare and Medi-Cal billing regulations by reviewing bulletins and billing manuals timely and making necessary system or workflow changes to ensure compliance.
MEASUREMENT: All billings are in compliance with Payer Contract, Medicare and Medi-Cal billing regulations. No facility is on Focus Medical Review for controllable billing non-compliance.
Ensures that all staff follow appropriate billing requirements and receives necessary compliance training.
Assures PFS billing products are accurate and patient friendly. Performs random review of charge audit findings to assure prompt response to repeat/recurring charge errors.
MEASUREMENT: Identified charge errors are not repeated. Upon approval, system and/or workflow updates are entered
within 7 days of request.
Ensures timely updates to the billing system for appropriate billing edits. Assures smooth, well-planned, computer conversions and upgrades. Performs all necessary testing and quality control functions to guarantee accurate and complete conversion of patient account receivables. Adheres to conversion schedules, checklists, and timelines to coordinate conversion and upgrade activities with peers and support staff.
MEASUREMENT: Conversion or upgrade is completed with all A/R identified and mapped according to conversion plan.
Implementations are optimized with no impact to net revenue or A/R days.
__FINANCIAL PERFORMANCE__
Manages Department budget within confines of approved budget. Contributes to the identification of and operationalizes cost reduction measures.
MEASUREMENT: Department expenses are within 95% - 100% of budget.
All cash receipts are posted prior to each month-end. Shared Services accounts are reconciled monthly. Action plans are developed and implemented, as necessary. Credit Balances are worked timely.
MEASUREMENT: Month-end closing includes all lockbox and hospital cash posted as well as appropriate account adjustments. Shared Service invoices processed monthly in a timely manner.
System enhancements that assist PFS in achieving department billing and cash goals are recommended and implemented.
MEASUREMENT: Implements 2-3 system improvements per year.
Meets or exceeds industry KPI’s for like facilities as reflected in Epic dashboard. Action plans developed and implemented in areas where opportunities for improvement are identified.
MEASUREMENT: KPI’s for A/R aging, cash collections, productivity, and denials prevention are at or above median performance for comparable hospitals.
__SYSTEM INTEGRATION__
Implements and provides training to Hospital Billing, Professional Billing, Single Billing Office staff to assure maximum competency in computer functionality, customer service, and general admission, insurance, and billing criteria. Participates in the development, implementation and maintenance of policies, objectives, short- and long-range planning; develops and implements projects and programs to assist in accomplishment of established goals.
MEASUREMENT: In collaboration with management team, defines and approves policies and procedures in a timely manner and responds to training documents with requested input and validation of information.
LEADERSHIP__
Enforces all policies in a consistent and fair manner. Manages and resolves all payroll, compensation, evaluation, training, hiring, termination, grievance, disciplinary, and development issues for assigned staff.
MEASUREMENT: All human resource issues are resolved in a satisfactory and timely manner with no more than 1 exception annually. 95% of performance reviews are completed on or before due date.
Creates an environment that fosters appropriate development and utilization of human resources. Effectively communicates external changes which impact the Department as well as organizational changes, issues, plans, and directives on a routine basis. Serves as a professional role model in overall conduct and communication.
MEASUREMENT: Maintains an availability to staff in informal and formal settings. Conducts at least 12 staff meetings per year at which System, Hospital, and Department issues are discussed. Meeting business is documented with minutes.
Topics to include several of the following:
Quality Improvement Financial Reports Customer Relations Insurance Updates Safety
Employee Recognition
Employee Motivation/Morale Enhancement
Assures that all staff training, training material, and training checklists are developed, current, and available to employees.
Knowledge, Skills, and Abilities
Exposure to and knowledge of the continuous quality improvement concept.
Strong professional level of written and oral communication skills.
Ability to defuse volatile situations, use good judgement and tact in dealing with the public.
Working knowledge of hospital and ambulatory care charging policies, contractual payment schemes, and collection agency policies.
Working knowledge of medical terminology, ICD9 coding, RVS coding, and CPT4 coding.
Ability to discuss personal and financial matters with patients or their representatives.
Ability to withstand pressure, meet deadlines, and positively react to stress associated with job duties.
Ability to use resources in an organized manner.
Bilingual preferred.
Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class.
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