Mgr PFS
Apply NowCompany: Lifespan
Location: Providence, RI 02902
Description:
Summary:
Reporting to the Director, the Manager plans and manages the key functions of Hospital and Professional Provider-Enrollment and Billing. Oversees and coordinates the credentialing process for new and established practitioners. Key responsibility is to ensure timely and compliant Provider Enrollment and billing of all Brown University Health claims.
Responsibilities:
Regularly collaborates with Director and Senior Management in development and implementation of short and long term administrative objectives and action plans of the department.
In conjunction with Senior Management, as appropriate:
Hires, coaches and motivates team; determines appropriate and effective performance metrics and staff requirements for the department to run with efficiency, accuracy and outstanding customer service. Implements and monitors staff productivity and service performance metrics. Oversees and manages the daily performance of billing staff
Effects consistent application of personnel policies and employee relations' activities as they pertain to staff. Consult with personnel representatives as needed to facilitate optimum results. Develops and implements department's administrative support policies and procedures.
Assists with development of all the department's priorities, procedures and policies for Brown University Health.
Develops processes and procedures for the efficient and successful flow of interdependent information between the billing team, other teams within patient financial services and teams outside of patient financial services.
Identifies the need for education and/or feedback to practice providers and staff and helps develop processes and educational materials.
Responsible for establishing policies relating to the revenue cycle and provider enrollment processes.
Plays a significant role in long-term planning, including initiatives geared toward operational excellence.
Works with other department managers and staff-including physicians, managed care, contracting, and other professional staff-to acquire necessary materials and information for provider certification and licensure to promote organization-wide compliance with provider-enrollment policies and procedures.
Assists in design, implementation and optimization of billing /enrollment systems, making recommendations for changes as necessary.
Performs ongoing provider database maintenance for accuracy and completeness.
Improves the operational systems, processes and policies in support of organizations mission, specifically in support of better management reporting, information flow and management, business process and organizational planning.
Stays abreast of industry changes, educates staff on these changes and updates other members of the team as appropriate.
Promotes a team-oriented environment that fosters effective collaboration within and outside of the department.
Serves as a resource to staff members on all billing issues and responds to inquiries as necessary.
Performs other duties as assigned.
Other information:
BASIC KNOWLEDGE:
Bachelor's degree in health services administration or five years' previous experience in Medical Billing and Provider Network Credentialing
Certification in procedural coding (preferably CPC).
EXPERIENCE:
Minimum of 5 years related experience and 3 years related management experience, with experience within a large integrated healthcare delivery system preferred.
Extensive knowledge of all government and third-party payer regulations and reimbursement practices for both hospital and physicians. Advanced knowledge of ICD-10, CPT-4 and HCPCS coding, medical terminology and third-party reimbursement policies required.
Current knowledge of NCQA and Medicare credentialing standards and other regulatory requirements
Knowledge of credentialing principles for provider networks/payors
Epic experience highly desired.
Broad knowledge in business administration, finance and healthcare administration. Thorough knowledge of third party commercial and governmental billing.
High level of organizational and interpersonal skills to interact with Senior Management on matters having multiple and varying impact on department financial objectives and to respond effectively to competing needs for resources.
Managerial skills to develop and supervise department support staff.
WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:
Work is performed in a typical office environment requiring extended periods of sitting, standing and walking.
INDEPENDENT ACTION:
Incumbent acts independently and in accordance with policies and procedures, referring unusual problems to the Director.
SUPERVISORY RESPONSIBILITY:
Supervises up to 30 FTEs
Work is performed in a typical office environment requiring extended periods of sitting, standing and walking.
Brown University Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor.
Location: Brown University Health Corporate Services, USA:RI:Providence
Work Type: Full Time
Shift: Shift 1
Union: Non-Union
Reporting to the Director, the Manager plans and manages the key functions of Hospital and Professional Provider-Enrollment and Billing. Oversees and coordinates the credentialing process for new and established practitioners. Key responsibility is to ensure timely and compliant Provider Enrollment and billing of all Brown University Health claims.
Responsibilities:
Regularly collaborates with Director and Senior Management in development and implementation of short and long term administrative objectives and action plans of the department.
In conjunction with Senior Management, as appropriate:
Hires, coaches and motivates team; determines appropriate and effective performance metrics and staff requirements for the department to run with efficiency, accuracy and outstanding customer service. Implements and monitors staff productivity and service performance metrics. Oversees and manages the daily performance of billing staff
Effects consistent application of personnel policies and employee relations' activities as they pertain to staff. Consult with personnel representatives as needed to facilitate optimum results. Develops and implements department's administrative support policies and procedures.
Assists with development of all the department's priorities, procedures and policies for Brown University Health.
Develops processes and procedures for the efficient and successful flow of interdependent information between the billing team, other teams within patient financial services and teams outside of patient financial services.
Identifies the need for education and/or feedback to practice providers and staff and helps develop processes and educational materials.
Responsible for establishing policies relating to the revenue cycle and provider enrollment processes.
Plays a significant role in long-term planning, including initiatives geared toward operational excellence.
Works with other department managers and staff-including physicians, managed care, contracting, and other professional staff-to acquire necessary materials and information for provider certification and licensure to promote organization-wide compliance with provider-enrollment policies and procedures.
Assists in design, implementation and optimization of billing /enrollment systems, making recommendations for changes as necessary.
Performs ongoing provider database maintenance for accuracy and completeness.
Improves the operational systems, processes and policies in support of organizations mission, specifically in support of better management reporting, information flow and management, business process and organizational planning.
Stays abreast of industry changes, educates staff on these changes and updates other members of the team as appropriate.
Promotes a team-oriented environment that fosters effective collaboration within and outside of the department.
Serves as a resource to staff members on all billing issues and responds to inquiries as necessary.
Performs other duties as assigned.
Other information:
BASIC KNOWLEDGE:
Bachelor's degree in health services administration or five years' previous experience in Medical Billing and Provider Network Credentialing
Certification in procedural coding (preferably CPC).
EXPERIENCE:
Minimum of 5 years related experience and 3 years related management experience, with experience within a large integrated healthcare delivery system preferred.
Extensive knowledge of all government and third-party payer regulations and reimbursement practices for both hospital and physicians. Advanced knowledge of ICD-10, CPT-4 and HCPCS coding, medical terminology and third-party reimbursement policies required.
Current knowledge of NCQA and Medicare credentialing standards and other regulatory requirements
Knowledge of credentialing principles for provider networks/payors
Epic experience highly desired.
Broad knowledge in business administration, finance and healthcare administration. Thorough knowledge of third party commercial and governmental billing.
High level of organizational and interpersonal skills to interact with Senior Management on matters having multiple and varying impact on department financial objectives and to respond effectively to competing needs for resources.
Managerial skills to develop and supervise department support staff.
WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:
Work is performed in a typical office environment requiring extended periods of sitting, standing and walking.
INDEPENDENT ACTION:
Incumbent acts independently and in accordance with policies and procedures, referring unusual problems to the Director.
SUPERVISORY RESPONSIBILITY:
Supervises up to 30 FTEs
Work is performed in a typical office environment requiring extended periods of sitting, standing and walking.
Brown University Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor.
Location: Brown University Health Corporate Services, USA:RI:Providence
Work Type: Full Time
Shift: Shift 1
Union: Non-Union