Manager Patient Financial Svcs/Hosp Billing

FLSA Status

Job Role Summary

Essential Functions and Responsibilities

• Proactively contributes to Eskenazi Health's mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County; models Eskenazi Health's values
• Directs and coordinates the daily operations of the hospital billing and follow-up staff to ensure claims are effectively and compliantly prepared and submitted, appropriate cash flow is maintained, patient satisfaction with the administrative functions are consistently positive, and appropriate collaboration with outside departments is maintained; serves as the operational liaison with billing vendors and monitors metrics and performance improvements
• Directs and coordinates a denial and appeal program/process for accounts where the hospital billing and follow-up team is unable to gain positive results from their initial appeal and follow-up activities; develops and maintains reporting on types and numbers of denials, appeals, cases won and lost, and other related reporting as needed; manages staff needed to carry out these functions
• Works with Director to carry out supervisory responsibilities including managing staff performance, work allocation, quality assurance, salary planning, training, development, hiring and placement
• In collaboration with Compliance, develops, implements and ensures compliance with billing standards and requirements; serves as a primary contact in managing third party payor audits involving hospital billing activities and is responsible for hospital billing department staff engaged in departmental audit functions
• Creates action plans, as needed, to address improvement opportunities and monitors their success
• Directs and reviews analyses, reporting, key performance indicators and operational metrics
• Ensures that the activities of the billing teams are conducted in a manner that is consistent with overall policies of Eskenazi Health, and are in compliance with federal, state and payer regulations, guidelines and requirements
• Assists with ongoing management of systems and provides operational oversight of departmental applications, including those related to claims preparation and submission, denials and appeals, and contract management tools
• Assists with the development of strategic plans and goals for continued improvement and service leverage acting as key leader to implement plans
• Participates in corrective actions in response to variances and trends
• Provides, oversees, and/or coordinates the provision of training and education for new and existing staff regarding applicable operating policies, payor and industry standards, protocols, systems and procedures, and techniques
• Works with the credentialing and managed care teams to resolve A/R issues; serves as a primary contact to the HIM staff relative to claims and AR concerns
• Troubleshoots current problems and anticipates potential problems, and resolves them by involving appropriate departments and personnel as needed, with the expertise to know when to collaborate with others to minimize loss of revenue, reimbursement, penalties or sanctions
• Provides leadership through effective guidance, feedback and delegation
• Ensures and advocates excellence in customer service values

Job Requirements

• Bachelor's degree, preferably in Business, Health or Public Administration, Management, or a related field; 8 years of experience in Revenue Cycle operations may be accepted in lieu of a bachelor's degree
• 5 years of management experience in hospital Patient Financial Services management is required

Knowledge, Skills & Abilities

• Advanced analytical skills
• In-depth knowledge of hospital, physician and mental health billing and reimbursement
• Knowledge of healthcare industry financial statistical indicators and best practices
• Skills in using mainframe and PC computers, including strong MS Excel skills
• Clear, effective communication skills
• Professional, team-oriented, solution-driven approach to problem solving for all types of issues
• Detail orientation
• Knowledge of medical terminology
• Critical thinking skills
• Effective project management skills