Professional Billing Operations Manager

Professional Billing Manager

HERS Advisors is seeking a Professional Billing Manager for a great health system in the Seattle area. They are seeking someone to assist with billing automation and workflow process implementation and improvement for professional billing. If you are interested in hearing more, please send an updated resume to hello@hersadvisors.com.

Reporting to the Director of Ambulatory Revenue Cycle, the Professional Billing Manager is responsible for the timely and accurate processing of professional billing and accounts receivables to achieve and sustain industry-leading performance and patient-friendly service. Has direct ownership of professional billing functions including claims filing and follow up, payment processing and posting, denials, self-pay billing, and customer service. Utilizing the Epic Revenue Cycle system, continually evaluates professional billing performance by monitoring dashboards, work queues, productivity reports and other related features. Drives efficiency gains through standardization and automation. Delivers exceptional results consistent with industry-leading key performance indicators. Develops and implements revenue cycle operational policies and procedures, evaluating and modifying as necessary to optimize performance. Develops and implements processes for new Ambulatory Division business lines established by the organization. Collaborates and communicates with Ambulatory Division leaders on performance metrics and opportunities for improvement.

Primary Duties

1. Manages revenue cycle activities to achieve best practice benchmarks for insurance billing, claim rejection, denial rates, account receivable turnover, collection rates for insurance and patient accounts, and customer service levels.

2. Directs oversight and support of the Professional Billing team. Prepares performance evaluations, coaches, counsels, and takes disciplinary actions as necessary.

3. Prepares the annual Professional Billing department budget to forecast staffing and non-staffing resource needs.

4. Responsible for scheduling oversight to ensure appropriate coverage of departmental operations.

5. Drives team performance to meet productivity expectations.

6. Responsible for the execution of annual revenue cycle financial performance improvement goals and objectives. Reports monthly progress as it relates to A/R days, cash collection, credits, bad debt, charity care, denials, and other assigned KPIs to the Director of Ambulatory Revenue Cycle, Executive Director of Revenue Cycle, Director of Finance, and Chief Financial Officer.

7. Provides oversight for the implementation of initiatives to optimize revenue cycle operations including use of the practice management systems, related interfaces, and other supporting technology.

8. Works closely with the Corporate Compliance department to ensure compliance with all billing rules, federal and state regulations. Knowledgeable in areas of billing regulations, charging requirements, and current and upcoming coding and reimbursement requirements.

9. Assists in the development, implementation, review and approval of policies and procedures related to Professional Billing operations.

10. Fosters positive team collaboration and staff development to facilitate efficient operations, employee engagement and achievement of patient satisfaction and employee engagement goals. Develops and maintains a collaborative relationship with the Manager of Professional Coding.

11. Participates in professional development activities and maintain professional affiliations.

12. Serves as knowledge leader on professional revenue cycle initiatives organization wide.

13. Aligns professional billing goals with organization goals

Accountabilities/Competencies

1. Proficiency in reading, writing, comprehending, and speaking English as required for business necessity.

2. Accountability for HIPAA privacy and security standards within the department or assigned nursing unit.

3. Must possess basic skills to use Microsoft Office, specialized software, and electronic office equipment.

4. Adheres to organizational patient safety standards relevant to the department or assigned nursing unit.

5. Prepares departmental goals, budget and operates department within approved budget.

6. Works collaboratively with other management staff to assist in program development, and to promote an understanding of the interrelationship of clinical and business activities within the district.

7. Coordinates and provides oversight in pulling billing related documentations as it relates to audits and participates in the audit process working group if applicable

8. This position requires demonstrated analytical experience and strong personal computer, communication, project management, leadership, problem solving, continuous improvement, customer service, team building skills and ability to develop strong relationships with physician and administrative leaders. Strong knowledge of financial and information technology, and business planning is required. Must have a history of developing constructive and cooperative working relationships with others over time is a must.

9. Must be an advocate of change management, effectively communicating and implementing change and managing it proactively. Must be an individual of high integrity, comfortable working in a team environment, possessing vision, solving problems through effective planning and management. Promotes teamwork and seeks to maximize the potential of all employees. Will serve as a facilitator of change and as a mentor and role model. Excellent communication and customer service skills are essential. Able to effectively communicate strategies and initiatives to internal management groups and business partners. Must be an individual of high energy with a positive attitude and track record of getting results. Experience in making and implementing decisions in a complex, consensus-oriented environment required.

Minimum Qualifications License, Certification, Education or Experience:

REQUIRED for the position: 5 years of Epic billing experience which includes at least 3 years of general leadership experience, to include management of people, projects and programs required.

DESIRED for the position: Bachelor's degree in Healthcare, Business or other related field, or equivalent work experience.