At Riverside, everyday brings new and exciting challenges. You can expect an interesting environment where you’re part of making sure our organization is running optimally and safely, helping keep the community healthy. We provide the kind of paid training and opportunities that long-term careers are built on and we recognize hard workers who strive to make a difference. You will be able to succeed in our close-knit, safety-focused culture working together as a team. The careers we offer are meaningful because the work we do matters. Join us!
FTE: 1.000000
Shift: Days
Location: RIVERSIDE MEDICAL CENTER
Summary:
Reporting to the Director of Home Health Care, the Post-Acute Billing Manager oversees and manages all billing, follow-up and appeals related to Post Acute service lines. The manager will coordinate efficiencies and maintain revenue integrity related to medical necessity, government audits and all billing and follow-up. Perform other patient accounting functions, as needed.
Experience/Education Requirements:
- Bachelor's degree in Business or a Healthcare related field is preferred.
- Previous Home Health billing (HMO, PPO) experience with knowledge of Medicare and Medicaid billing regulations, Florida shared system desirable.
- Minimum five years’ experience working in a healthcare billing field.
- Previous supervisory or management experience desirable.
- Ability to work independently and execute critical decision making involving governmental payer compliance.
- The ability to remain calm in high stress situations.
- The ability to work a varied schedule and fulfill on call requirements and the ability to travel to offsite segments of the Riverside Medical Center campus and work remotely for extended periods of time.
License or Certification Requirements:
n/a
Responsibilities:
- Subject matter expert for billing and reimbursement related to both PDPM and PDGM.
- Leads, manages and improves processes, policies and procedures, and technologies.
- Oversee and manage the billing and follow-up staff assigned to Post-Acute Care service lines.
- Interprets regulations relative to billing and collection and maintain education, training and staff's knowledge of regulations guiding their roles.
- Evaluate outstanding A/R via ATBs, Dashboards, WQ Monitoring, various reports and works to align the team with designated key performance indicators to achieve goals on a monthly and annual basis.
- Develop, implement and evaluate existing policies and procedures related to the billing and collections, in accordance with licensure and regulatory compliance, sound business practices, and congruent with standardized practices within the industry.
- Coordinate educational opportunities within the department/team and identify and resolve user skill gaps. In addition, work with Epic Certified Trainer to develop tip sheets and visios.
- Works closely with clinical, supervisory and record review/Oasis/MDS staff in promoting processes which allow for the efficient and accurate flow of information from clinical to billing.
- Identify and communicate system issues related to billing, follow-up work queues and other identified miscellaneous issues with the Epic Coordinators and Home Health Director.
- Submit help tickets and work with Epic Application Coordinators and/or Analytics to resolve issues, including testing and training as necessary.
- Maintain payor spreadsheets and attendance at Managed Care In-services, onsite meetings and conference calls with Insurance Provider Representatives.
- Assist with the development and review of appropriate contract language for Post-Acute care service lines.
- Provide feedback of insurance trends to the Revenue Integrity Manager and Patient Financial Service Director.
- Organizes and monitors the productivity and quality of assigned staff. Create and implement metrics for productivity and quality, maximizing staff's efficiency and issues resolution.
- Performs duties related to timekeeping.
- Works with patients/customers/third party payors to resolve billing and collection questions.
- Works with outside attorneys and collection agencies.
- Prepares documents required by payors, internal and external auditors.
- Regular rounding with staff.
- Supports IDT as r/t pt coverages, information, update of financial status in eMAR carve out or consolidated billing
- Oversight of submission of PBJ to CMS and other time sensitive reporting to HFS or IDPH as required
- Update demand bill log – must stay in compliance for IDPH
Collaborates with Business Office including medical records and revenue cycle
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Riverside Healthcare is revolutionizing care using leading-edge technology to diagnose and treat patients. We are ranked top in the nation for performance in neurosurgery, orthopedics, and heart surgery and have also been named one of the nation's 100 Top Hospitals by Truven Health Analytics seven times. Riverside is nationally recognized for our specialty programs in obstetrics, trauma, oncology, rehabilitation, geriatrics, occupational health, psychiatric services, and treatment of alcohol and chemical dependency, as well as patient safety. We combine innovation and convenience at state-of-the-art facilities located in communities throughout the greater Kankakee area.
Riverside Medical Center proves that truly progressive medicine is being delivered in Chicago's southwest suburbs and East Central Illinois. Join a team that is not only concerned with providing the best care possible but also with offering a work environment of advancement and growth. Riverside is a place that embraces a culture where opinions count and dedications is respected, where superior performance is rewarded with competitive salaries and excellent benefits.
Other information:
Exposure/Sensory Requirements
Exposure to:
Chemicals: None
Video Display Terminals: Average
Blood and Body Fluids: None
TB or Airborne Pathogens: None
Sensory requirements (speech, vision, smell, hearing, touch):
Speech: Command of English language, good speaking for verbal communication with public and employees.
Vision: Required to see computer screens, papers, fax, printer, written materials.
Smell:
Hearing: Must be able to hear for verbal and telephone communication.
Touch: Computer, telephone, handwriting
Activity/Lifting Requirements
Average Hours per Week:40
Shift:Days
Percentage of time during the normal workday the employee is required to:
Sit: 75%
Twist: 0%
Stand: 10%
Crawl: 0%
Walk: 5%
Kneel: 2%
Lift: 1%
Drive: 0%
Squat: 2%
Climb: 0%
Bend: 3%
Reach above shoulders: 2%
The weight required to be lifted each normal workday according to the continuum described below:
Up to 10 lbs: Continuously
Up to 20 lbs: Occasionally
Up to 35 lbs: Occasionally
Up to 50 lbs: Not Required
Up to 75 lbs: Not Required
Up to 100 lbs: Not Required
Over 100 lbs: Not Required
Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.):
>Maximum consecutive time (minutes) during the normal workday for each activity:
Sit: 360
Twist: 0
Stand: 30
Crawl: 0
Walk: 10
Kneel: 1
Lift: 5
Drive: 0
Squat: 5
Climb: 0
Bend: 5
Reach above shoulders: 5
Repetitive use of hands (Frequency indicated):
Simple grasp up to 10 lbs. Normal weight: 5# continuously
Pushing & pulling Normal weight:
Fine Manipulation: Telephone, sorting papers, computer entry, writing, using fax, printers, typing.
Repetitive use of foot or feet in operating machine control:
Environmental Factors & Special Hazards
Environmental Factors (Time Spent):
Inside hours: 8
Outside hours :
Temperature: Normal Range
Lighting: Average
Noise levels: Average
Humidity: Normal Range
Atmosphere:
Special Hazards:
Protective Clothing Required: