Job details
Job Type: Behavioral Health Accounts Receivable Manager and Coding
Full-time
1 Westinghouse Plaza
Boston, MA 02136
Full Job Description
We have provided behavioral healthcare services to community members informed by up-to-date, bona fide research on factors leading to positive outcomes in psychotherapy since 2017.
Our philosophy is to live in integrity, lead by example, and create a strong sense of self and community. We are committed to helping the members of our community to restore balance and integrity in their family, academic and social situations.
Our multidisciplinary teams work with adults and youth in the Boston Metro Area to enhance social-emotional development, prevent the development of mental health challenges, and address social-emotional problems that currently exist. We utilize evidence-based strategies in our service delivery model, uniquely designed to assist each individual in successfully accomplishing their goals innovatively and begin the process of healing.
We are looking for a Behavioral Health Accounts Receivable Manager and Coding.
Position: Billing and Coding
Schedule: Full Time
POSITION SUMMARY:
The Professional Billing and A/R Manager will be responsible for oversight of coding and Accounts Receivable for our behavioral health department’s professional billing and revenue cycle. Management oversight of professional and Clinic billing business related functions.
ESSENTIAL RESPONSIBILITIES / DUTIES:
Billing Work queue
- Monitors coding requirements and submissions to maximize revenue and comply with regulations. Annually reviews fee schedule to ensure the appropriateness of charge level. Keeps up to date on laws, regulations, and healthcare trends that affect the practices' business systems and operations.
- Monitors coding and denial edits and is the resource for medical billers for coding related matters.
- Back up coding for deliveries and surgeries and rounding services.
- Reviews charts for documentation and signature. Assures appropriate ICD -10 and CPT codes applied to billing in work que routers. Adds diagnosis codes or corrects missing/incorrect elements to submit electronic billing. Where appropriate, provides education directly to clinicians to prevent repeat errors.
- Rewrite departmental procedures as a result of changes, and provide statistics on quality, service, and financial performance
- Monitors the Epic work-queue denials. Frequently monitors denial reports and trends for revenue improvements.
- Researches and documents any questionable item causing the denial or underpayment of claims and makes efforts to facilitate appeal, re-bill, or seek solutions for future improvements.
- Works collaboratively with clinic staff to proactively ensure proper prior authorizations are in place for clinic visits, procedures, and OR cases. Involved in resolving any post-bill prior authorization issues.
Revenue Cycle Performance
- Demonstrate proficiency in both Front End and Back End operations to achieve increased collections, optimal billing goals, and adherence to compliance rules and regulations.
- Understands the implication of each element in the revenue cycle, communicates this to group/practice to engender an appropriate response. Provides interpretation to clients/PBO Management. Develops interventions and initiates actions
- Focus practice(s) on issues that will positively or negatively impact financial performance by reviewing coding
- Act as an internal consultant provides essential quality reports, and advice and improvement recommendations to the management team
- Required to understand and communicate complex issues and changes relating to the industry revenue cycle and regulatory compliance, third-party reimbursement to the department(s) involved, maintaining records of their notification, accountability and compliance.
- Work closely with Clinic departments to provide accurate, critical information for identification of areas needing revenue or compliance improvement attention to expedite resolution.
- Provide updates on global issues regarding coding and reimbursement practice(s). Assesses the impact of new regulations or codes from a coding, compliance, and reimbursement perspective.
- Provide vision and management expertise in guiding the complete process re-engineering of professional billing including but not limited to:
- Assist in the development model that supports CLINIC’S Patient First Initiative
- Help create and promote a "customer service" oriented work environment
- Work with ITS Department to develop a new and innovative technology infrastructure to support the design (CLINIC’S Pros project)
- Institute mandatory training, certification, and continual quality audits. (Performance standards)
- Assist in the development and lead new training program that will support the change in the operational and service-oriented paradigm
Financial Operations
- Create operational protocols and use statistics/metrics to determine overall performance and effectiveness, team performance and error rates, deficits in systems, etc.
- Conduct analysis, verification, and reporting of all revenue cycle-related reconciliation processes and performance.
- Works with departments to modify procedures and update information (i.e. update practice level pick lists, billing instructions). Shares information with PBO staff to enhance departmental efficiency/performance (i.e. notifies ADs of audit and compliance risks, identifies issues through rejection or receivable analysis.)
- Supports the integration of new physicians/practice(s) into the Departments by providing professional charges by CPT code and assisting in the orientation/training of physicians
Revenue Cycle Reporting
- Prepares monthly reports on accounts receivable for review and analysis.
- Provides management team with statistical reports including but not limited to professional billing-related edits, service to post-date lag time, charges held due to provider credentialing, monthly write-offs, payer rejections and claim denials.
- Develops expertise for assigned practice(s). Works with practice leadership on annual budgeting, forecasting, and analysis for potential new business opportunities
- Will be required to meet with Department Directors regularly to build consensus on strategy; rewrite departmental procedures as a result of changes, and provide statistics on quality, service, and financial performance
- Reviews and responds to financial data for the physician practice
- Develops and maintains a good working relationship with the billing vendor.
- Works closely with the billing vendors to evaluate areas of needed improvement. Makes recommendations for improvements and upon approval, implements and monitors account receivable status.
- Attends Operation and Performance meetings for all groups.
Other
- Establishes and develops collaborative relationships with internal staff.
- Provides back-up assistance to departments if needed
- Provide continuing education to staff and providers on an as-needed basis
- Oversee activities to ensure goals and objectives are met by the specified target dates
- Conform to hospital standards of performance and conduct, including those pertaining to patient rights, so that the best possible customer service and patient care may be provided.
- Utilize hospital's values and behavioral standards as the basis for decision making and to facilitate the hospital's goals mission.
Must adhere to all of CLINIC’S RESPECT behavioral standards.
EDUCATION:
Bachelor's Degree in Business / Healthcare related field or work experience equivalent.
CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:
Certified Coder (CCP) preferred
EXPERIENCE:
Minimum of 5-7 yrs related experience required. Specifically, experience in an academic medical center managing professional billing functions. 3 - 5 years GE and/or SDK system experience preferred
KNOWLEDGE AND SKILLS:
- Advanced knowledge of healthcare revenue cycle functions, including coding and billing guidelines, government payer regulations. Must have CPT coding knowledge.
- Working knowledge of payer reimbursement and rules.
- Experienced in auditing, training, and communicating revenue cycle regulations and concepts.
- Excellent interpersonal and communication skills to positively interact with a variety of hospital personnel, including physicians and administrative and management staff.
- Strong analytical skills.
- Highly skilled experience and knowledge of Windows-based software required, including but not limited to Microsoft Windows, Outlook, Excel, and Access.
- Proficient skills to collect, organize and analyze data, produce actionable reports and recommend improvements and solutions.
- Possess effective oral and written skills.
- Ability to interpret and implement regulatory standards.
- Working knowledge of multiple healthcare applications, including but not limited to SDK / Eclipsys, GE.
- Possess effective time management skills to permit handling of a large workload.
Job Type: Full-time
Pay: $34.00 per hour
Expected hours: 40 per week
Benefits:
Schedule:
- 8 hour shift
- Monday to Friday
Work setting:
Work Location: In person