Summary

 

In this role, you will be responsible for ensuring that goals and objectives of the RCM team  are properly defined and clearly established.

 

Key Roles & Responsibilities

 

• Manage a staff of up to 20 Reimbursement and Coding Specialists holding them accountable to productivity and accuracy benchmarks 


• Ensure that department activities are managed pursuant to the Polices & Procedures Manual


• Report and explain benchmarking metrics for all functional areas of department


• Compile, analyze, and prepare various status reports for senior management review to identify trends and make recommendations


• Maintain up-to-date expertise and knowledge of Physician Ambulatory billing and related laws and regulations


• Ensure claim denials are being reviewed and analyzed to determine if automated rules can reduce certain denials


• Provide provider coding audits on an as needed basis


• Provide coding education and training to providers on an as needed basis


• Responsible for coordination of all external coding and documentation audit activities with outside consultants and third party payers including Federal and State agencies (i.e., RAC, CERT, PCA, MAC, ZPIC etc.).


• Reviews and studies all information published by CMS and the OIG via the Federal Register, fraud alerts, OIG advisory opinions, and other publications relative to coding, billing and reimbursement compliance.


• Reviews and studies all information from third party payers relative to claims filing, coding, and the adjudication process


• Proven ability to provide feedback and training to physicians and company leadership regarding federal and state coding regulations, medical documentation, and compliance guidelines; audit results; and risk areas.


• Strong familiarity with medical terminology and the patient medical record required. Knowledge of multiple EMR systems required (Allscripts PRO, Allscripts Touchworks, Athena a plus)


• Works with Director of Revenue Cycle Management to establish baseline benchmarks for department functions and department staff member productivity


• Handles escalation of complex patient and/or Physician requests and/or complaints


• Performs Annual employee reviews of direct reports


• Represent UH | CNMG's at business meetings with billing partners/vendors, clients, and other related organizations


• Assist Director of Revenue Cycle Management with the managing and maintenance of multiple RCM system applications. Includes adding/editing Providers, Insurance Carriers, CPT Codes, Diagnoses, Practice Locations, coding rules, and system upgrades


• Work closely with Director of Revenue Cycle Management and EMR department to ensure EMR templates are designed to maximize payor reimbursement


• Assist Director in managing multiple revenue cycle groups and multiple Practice Management Billing systems to include several New England locations.

 

 

 

Qualifications

 

• Education and Experience:
  
  
  
  
  • High School diploma or GED required
  
  
  • Associates Degree desirable
  
  
  • Certified Professional Coder (CPC) desirable
  
  
  • Minimum 10 years of experience preferred in Physician Healthcare billing. Practice Management experience a plus
  
  
  • Minimum 5 years of experience in a Management role required
  
  
  
  


• Personal Qualities
  
  
  
  • Innovative
  
  
  • Resourceful
  
  
  • Independent
  
  
  • Enthusiastic
  
  
  
  


• Computer skills
  
  
  
  • MS Office, especially Excel
  
  
  • Crystal Reports desirable
  
  
  • Business Intelligence application (Precision BI a plus)
  
  
  • Practice management applications (Allscripts Ntierprise and Athena a plus)
  
  
  • EMR applications (Allscripts PRO, Allscripts Touchworks, Athena a plus)
  
  
  
  


• Broad understanding of Medical billing and RCM operations.


• Proficient in CPT/ICD-10 Coding and Billing.


• Skillful in problem resolution.


• Encourages teamwork, energetic, and positively motivates teams and individuals.


• Excellent analytical and problem solving skills.


• Excellent oral and written communication skills.


• Excellent organizational and time management skills.


• Ability to work both independently and within a team.


• Ability to handle multiple assignments simultaneously.


• Ability to lead others toward objectives and goals.