Manager, Accounts Receivable

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Company: Orthopedic One

Location: Westerville, OH 43081

Description:

  • POSITION SUMMARY
    Oversees staff responsible for collection of payments at the highest level of reimbursement allowed for the patient medical services provided, including credentialing, contracting, variance analysis and data reporting.
  • RESPONSIBILITIES AND ACCOUNTABILITIES
    • Department:
  • In conjunction with Director, Patient Accounts, establishes department collection guidelines and procedures for timely resolution of outstanding insurance balances including documentation requirements for notes of actions taken on claims.
  • Assigns A/R work to staff to ensure reimbursement occurs prior to timely filing requirements including ensuring team members complete to-dos within established timelines based on criticality.
  • Manage A/R teams to ensure timely and accurate delivery of reports for the organization and maintain department key performance indicators.
  • Analyze monthly revenue cycle operations dashboard for denials, compliance, A/R Aging, A/R Days and various revenue cycle metrics.
  • Identify A/R denial trends through root cause analysis and work towards solutions by identifying efficiencies with EHR, WorkFlow Applications or Payer policies.
  • Collaborate with Insurance Payers, CMS, BWC and other organizations on ensuring proper complaint payment of claims.
  • Assist with Payer Enrollments, Credentialing and Contracting.
  • Assist with identifying variances in the charge master and proper contractual payment of claims.
  • Manage staff who review payer denial documentation and gathers necessary documentation and evidence to support the appeal and/or submission of a corrective claims including:
    • Registration Denials: Determining if claim was submitted to proper payer
    • Prior Auth Denials: Determining if pre-authorization was properly obtained
    • Compliance and Medical Necessity Denials: Determining if payer medical necessity requirements were met including support for surgery assist for advanced practitioners.
  • Implement and maintain a denials team to submit appeals and assist with compliance of our contractual obligations.
  • Coordinate with coding team to review coding and resubmit claims as necessary, provide related physician education denials and key payer trends.
  • Develop and present educational materials to train new staff members, operations and Physicians.
  • Maintain necessary operational skills and knowledge to perform staff responsibilities.
  • Collaborate with departments to identify denial prevention and opportunities for prevention.
    • Management:
      • Works with HR to interview and select staff and timely completion of related documentation
      • With HR Support, ensures performance appraisals define and measure a high level of work performance
      • Completes introductory and annual performance appraisals based on observed behaviors and work outcomes supported by appropriate documentation
      • Works to understand how staff are motivated and balance the needs of the organization and the individual. Sets expectations and rewards staff or achieving desired performance
      • Initiates coaching, disciplinary action, and performance improvement planning to address violations of policy and/or poor performance
      • Facilitates conflict resolution with staff with support as required based on circumstances
      • Ensures that Orthopedic One's mission, Patients First, is part of all management decisions and interventions.
    • Orient and Train Staff:
      • Orients new staff, ensuring they know the purpose of the organization, their department and position
      • Ensures that employees have resources, tools, feedback, assistance and training needed to achieve desired performance including productivity and qualitative expectations.
      • Provides effective and timely on the job training such that performance objectives are clear, staff members have knowledge and skills necessary to perform effectively
      • Builds learning into work performed such that staff gains increasing understanding of how and why work is performed
      • Instruction and information provided to staff results in complete understanding
      • Educates staff on all applicable new or established policies, procedures, and expectations.
    • Leadership:
      • Supports the mission, vision, values and code of conduct, goals and objectives of Orthopedic One, in customer care, community interactions, and management responsibilities.
      • Proactively reviews metrics important to the department workflow including work volume, customer satisfaction measures, etc. and makes recommendations to modify schedules, staff hours/staffing levels, and workflows to maintain productivity, quality and accuracy. Communicates metrics with staff timely and in mediums that maximize understanding.
      • Decisions, including those pertaining to staff, reflect complete and accurate analysis of relevant issues (past practices, work history, individual and group performance, department and company needs, consistency, fairness, regulatory or legal concerns, etc.)
      • Responsible and accountable for budget planning and cost control in area of responsibility.
      • Adheres to and administers company policies and procedures consistently and fairly in all matters (Employee Handbook, P&P, Risk, etc.)
      • Manages time and attendance to ensure employees are paid accurately and consistently based on company practices and policies.
      • Maintains department schedule/calendar and provides timely response to PTO requests
      • Promotes and supports an environment in which leaders and staff members engage in appropriate professional development, continuing education, and lifelong learning opportunities.
      • Submits reports/documents to appropriate parties in a complete, accurate and timely fashion (Personnel Action Notice, expense reports, etc.)
    • Professional Development:
      • Prepares appropriately to attend and participate in company meetings or projects as assigned
      • Facilitates special projects or assignments at the request of management
      • Attends to own professional development responsibilities and encourages/plans for staff to do the same.
  • TEAMWORK
    • Teamwork:
      • Willingly provides coverage, volunteers assistance, and maintains workflows within department as needed without direct instruction/supervision.
      • Works cooperatively and refrains from participating in negative conversations.
      • Shares knowledge and insights with co-workers in a constructive manner.
      • Works to solve problems and address conflicts with appropriate person directly before involving leadership or uninvolved peers.
      • Is considerate of others in the work environment with regard to taking breaks or meal periods, use of computer and phone, noise level in the department, etc.
  • QUALIFICATIONS
    • Education, Experience, Certification and Licensure Requirements:
      • Position requires an Associate's degree in business administration or related field. The applicant must have a minimum of ten years of experience working in a business office setting, preferably in healthcare revenue cycle, along with two years of supervisory experience. Previous experience with Microsoft Office Suite, and EMR/Practice Management software is required. Experience managing KPI reporting desired.

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