Manager Hospital Billing & Collections

Manages all aspect of hospital billing and DNFB. Responsible for ensuring compliance to all regulatory bodies as well as payer specific requirements. Understands hospital reimbursement methodologies and evaluates any billing changes against expected reimbursement. Ensures goals are achieved by maintaining fluent processing for timely claim submission. Identifies, monitors and reports issues as they arise and appropriate resolutions. Identify and coordinate performance improvement initiatives both, internal and external. Work with all levels of staff, management and payers to reduce denials and underpayments.

Well versed in all aspects of the revenue cycle and the impact to billing. Work closely with the professional billing manager to understand the impact of updates, system changes and processes on their team.

Analytical problem solver, detailed oriented. Focused on compliance, key performance indicators and efficiency. Strong ability to quickly assess current procedures/problems and develop and implement resolutions. Demonstrate employer of choice values such as fostering collaboration, team spirit and providing a positive motivating environment. Participates in planning, implementation, management and evaluation of service/department activities for Children's National in accordance with accepted national standards and administrative policies.

• Manage human resource activities of assigned team members, including selection and termination, training and development, evaluation and scheduling.

• Develop staff qualifications and performance criteria. Update Director on staff performance and progress toward criteria. Participate in employee development criteria and selection.

• Update staff with relevant information from Hospital and CNMA via written communication or staff meetings.

• Represent staff interests in committees.

• Coordinate work flow of staff, considering work load, priorities and available resources; promote an environment to support and recognize team and individual contribution.

• Document policies and procedures; communicate development and change to staff; contribute to ongoing review of policies and procedures.

• Lead or co-lead denial work groups; manage reports, data and root cause issue & resolution report; ensure progressive action to reduce denials & underpayments.

• Coordinate projects related to payer performance and work with Managed Care and others to address issues.

• Identify potential billing compliance issues, assess risk and research resolutions; work closely with Compliance Department to prioritize and correct; represent Business Operations concerns at meetings with other departments and report back to Director of decisions that affect the accounts receivable.

• Work with Federal, State, and local authorities in reviewing regulatory issues that affect submission and adjudication of bills.

• Support decision making process with operational data and information.

• Implement strategic plan through management of day to day operations of department/service area; troubleshoot operational issues/barriers. Collaborate with Director on significant operational issues/barriers.

• Take an active role in reviewing Account Receivable to identify problems and work to resolve issues; monitor patient information data entry for quality assurance; follow up on available related performance issues with management, training staff and individual employees.

• Monitor accounts daily to maximize reimbursement opportunities; support staff efforts in account development; develop tools to assist staff in efficiency and effectiveness.

• Audit managed care contract compliance and payer performance regarding reimbursement; report findings and implement corrective action to resolve; identify and report any model discrepancies in PCON & Trendstar; work with appropriate individuals to resolve.

• Manage recoveries of underpayments/appeals utilizing both internal and external (vendor) resources; provide documentation, reports and other communication regarding individual accounts.

• Review & report denial trends and identify internal and external causes; initiate and coordinate process improvement initiatives and solutions.

• Manage bad debt process to ensure compliant, timely and within budget; manage all vendor placements, stats and processes; update process as appropriate to ensure best performance.

• Develop and maintain communication network with third party payers; keep abreast of managed care contractual requirements and payer specific requirements and policies to include billing & reimbursement policies and clinical policies as they relate to denials and reimbursement.

• Manage facility billing team. Ensures timely, accurate & compliant billing of accounts receivable; manage & report all prebilling functions to include DNFB both IP & OP; ensure timely reconciliation of authorization & LOC authorization process; identify process improvement opportunities and implements solutions.

• Ensure operations of daily import/export process with STAR and TSH acknowledgement reports; monitor biller payer report assignments and correction/rebilling of denied claims; attend payer related seminars and communicate new requirements to staff and affected departments.

• Monitor changes in daily failed volume and payer mix as compared with staff assignments.

• Research Federal, CPT , ICD9, HIP AA and local billing transmission standards and law for 837 and UB92 claim filing.

• Communicate requirements to interested departments and apply billing standards to Hospital Claims Processing.

• Work with Managed Care Department to resolve payer related billing issues.