Manager, Patient Accounts Contract

Cleveland, OH, USA
University Hospitals
Description

Position Summary:

Plans, organizes, controls, standardizes and directs UH CBO Insurance collections employees, processes and strategy. Manages day to day operations of the Revenue Cycle billed AR to ensure the efficient and expected cash collection through productive and timely claim submission, follow-up, denials management and appeal activity to ensure  expected payment of insurance and/or patient claims for all hospital services billed through the Central Business Office.  Remains current for self and staff with governmental and third party billing, follow-up and appeal requirements for compliant billing and follow-up of both inpatient and outpatient claims for all wholly owned facilities. Performs departmental audit review and resolution processes in accordance with organizational requirements for areas of responsibility. Works closely to support RCM Senior leadership to coordinate support and hand offs between Pre-billing/billing, Hospital Financial Counselors, Customer Service, Self-Pay Collections and Physician A/R teams to optimize patient experience and collections.   Leadership role responsible for managing secondary billing office vendor relationships and performance designed to optimize net revenue.    Works closely with Managed Care, Payers, Finance and Operations to communicate A/R performance and resolve A/R issues and drive process improvement.

The position is responsible for an estimated 70 to 80 FTEs, including 4 supervisors and annual hospital insurance collections of over $1.8B.

Establishes, enforces and ensures standards of performance and behaviors, monitors and analyzes departmental service standards for Insurance Follow up Insurance collections, and responds timely with Customer Service to respond to in-bound patient call activity to ensure our patients receive superior service.   

The position is responsible for adhering and creating Insurance Collection policy and guidelines in coordination with RCM Senior Leadership, as well as driving insurance collection strategy, analysis, monitoring payor performance, as well as oversight of Denials, Credit Management and Post Payment Review.  Supports in decisions and strategy associated with on line and other technology solutions as well as pre collect, collection and other vendors contracted to optimize patient collections.  Ongoing alignment and strategy to coordinate and follow processes implemented by CBO.

Understands and supports internal and external relationships including I.T., Legal, Compliance, Internal Audit as well as vendor relationships to ensure compliant revenue transactions for each of the 7 Core Hospitals (Case, UH Regional, Ahuja, Geauga, Geneva and Conneaut)

Essential Duties: 

• Directly oversees multiple supervisors and 70+ staff members, and is responsible for ensuring staff work quality and output is satisfactory and issues addressed and/or resolved.  Responsible for all hiring and related personnel decisions, completing routine performance review evaluations, training, scheduling, and process documentation.
• Responsible for cash collections of approximately $1.8 billion.
• Reviews, sets and communicates department productivity standards and AR goals for the team. Ensures Supervisors and staff members are meeting quality and productivity standards by performing/reviewing routine audits.  This also includes conducting routine staff audits for productivity and tracking results. 
• Provides month-end AR reports to leadership on active AR dollars.
• Maintains in-depth knowledge of system software including primary financial systems, claims systems, and cash posting systems.
  • Provides extensive customer support service, acts as a liaison for both internal and external customers providing assistance in claims submission and resolution. Resolves escalated patient complaints.
• Generates and analyzes reports for AR review and resolution to include root cause definitions.
• Generates, monitors, analyses and reviews reports to assist with Post-Pay issues and resolution resulting in additional cash recovery acting as primary liaison for all departments and external agencies.
• Generates, monitors, analyses and reviews Denial management reports to assist with issue and trend resolution resulting in additional cash recovery acting as primary liaison for all departments and external agencies. 
• Acts as primary contact meeting with SBO administrators on a regular basis, leads assignments and process improvement, and monitors SBO inventories to ensure timely resolution of accounts.
• Acts as primary liaison with UH Legal and addresses any claims related to risk issues to resolve balances.
• Acts as primary contact for outside discount agencies working on behalf of commercial carriers looking for reductions on UH Claims, manages communications and individual LOA’s that are claim specific.  
• Participates/leads in payer, departmental and Hospital specific AR task force meetings.
• Responsible for providing feedback suggestions and process improvement recommendations to leadership.  Identifies opportunities for process improvement by recognizing issues based on delayed billing or payments.  Provides timely feedback to peers in operational areas and leadership to improve Revenue cycle processes. Participates in process improvement initiatives throughout the entire revenue cycle operation.
• Initiates and leads special projects.
• Responsible for maintaining relationships with external vendors and third party payers regarding claim/contracting issues to maximize reimbursement for the Health System.
• Plans, develops and monitors department operating budget.
• Maintains in-depth knowledge of policies, procedures and laws relating to medical insurance company billing.  Ensures departmental compliance.
• Identifies billing errors, and follows-up with staff members/third party payers to ensure resolution.
• Identifies trends with third party payers, and coordinates and implements changes for improved billing methods. 
  • Analyzes and resolves claims; contacts patient, guarantors, and/or third-party organizations to secure information as needed; prepares and maintains patient billing records to assist in the adjudication of difficult claims.
  • Oversees and assists supervisors with orientation and training in Revenue Cycle Policies for billing and follow-up to ensure maximum reimbursement for CBO.

*This role may encounter Protected Health Information (PHI) as part of regular responsibilities.  UH employees must abide by all requirements to safely and securely maintain PHI for our patients.  Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace

Qualifications

Education:

Bachelor’s degree required

Experience & Knowledge:

• Minimum 5 years of progressive experience in healthcare revenue cycle operations required.
• Minimum 2 years supervisory experience required, which includes experience hiring, training, evaluating, disciplining, developing and engaging staff members required.
• Must have working knowledge of claim submission, (UB04/1500) and third party payors.
• Knwledge of Federal Billing Regulations required.
• Must be detail-riented and organized, with good analytical and problem solving ability. 
• Ntable client service, communication, presentation and relatinship building skills required. 
• Ability t function independently and as a team player in a fast-paced environment required. 
• Must have strong written and verbal communication skills.

Special Skills & Equipment Knowledge:

• Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, FAX machine, etc.) required.

Oracle, Kronos, Soarian, and/or IDX experience preferred

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