Position Details

Benefit Eligible and Accrues Time Off

Work Hours per Biweekly Pay Period: 80.00

Shift : Monday - Friday

Location : 210 South Florida Avenue Lakeland, FL

Pay Rate : Min $67,267.20 Mid $84,073.60

Position Summary

Demonstrates commitment to the vision, core purpose/mission and goals of LRMC, modeling the values and culture. Conducts performance reviews, assigns employees work, schedules, time off, determines priority of work to be done. Oversees day-to-day operations: Managing Cash Posting processes and staff, Managing Billing Processing and Staff. Initiates and coordinates research, analyzes reports and other data to assure that quality and productivity are in alignment with industry and institutional standards (99% accuracy rate) as well as identifies any issues that impact timely billing and claim payment. Has consistent communication with the team, supervisor(s) and/or team lead regarding expectations, changes and any and all regulatory changes or implementations, or any other communications essential to the team and team development. Uses discretionary judgment in the management of staff, customers and visitors. May provide staff education and training. Serves as key resource for staff in their day-to-day job duties. Identifies and facilitates opportunities for improvement in the areas of quality care and services, stewardship, employee satisfaction, communication, accountability, and customer satisfaction.

Performs other duties as assigned.

Position Responsibilities

People At The Heart Of All That We Do

• Fosters an inclusive and engaged environment through teamwork and collaboration.
• Ensures patients and families have the best possible experiences across the continuum of care.
• Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.

Safety And Performance Improvement

• Behaves in a mindful manner focused on self, patient, visitor, and team safety.
• Demonstrates accountability and commitment to quality work.
• Participates actively in process improvement and adoption of standard work.

Stewardship

• Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
• Knows and adheres to organizational and department policies and procedures.

Standard Work: Manager - Billing/Cash Posting

• Utilizes previous experience in adjudication of bills, and accounts receivable functions. Resolves billing and collection issues. Manages resubmissions of billing denials and ensures that department is maximizing reimbursement to efficiently lower A/R and speed up revenue cycle. Responsible for ensuring all claims are worked in a timely manner within Billing System and the Clearinghouse, to ensure timely filing limits are obtained. Monitors daily claim files, Exported/Transmitted claims. Actively participates in team development, achieving dashboards, and in accomplishing department goals and objectives. Using a collaborative leadership style, facilitates the achievement of department and hospital-wide quality, safety, satisfaction and stewardship goals. Monitors and tracks data/reports as identified by the department leadership.
• Ensures cash optimization and accounts receivable reduction activity is functioning to fullest capability. Maximize technology use for timely productivity on claims follow-up, payment posting and status review. Schedules and assigns staff to ensure that workload is met, monitors work ques and ensure that cash posters work their remits per daily deposit and distribution.
• Responsible for overseeing the orientation of new employees, continually assessing the employee competencies, and for performing annual reviews on staff based on the guidelines and timelines set by the organization. Mentors/Coaches employees and focuses on ongoing staff development working with employees to address any performance issues to facilitate effective relationships and outcomes.
• Works collaboratively and takes a proactive approach to communicate errors to the appropriate staff, clinics, departments, physicians, and other Management as necessary. Responds to complaints, adverse situations, unplanned circumstances or problems to ensure that work is completed efficiently, staffing needs are met, customer and staff satisfaction concerns are addressed appropriately and expected outcomes are achieved.
• Adheres to compliance and departmental policies and procedures including compliance with 100% of HIPAA requirements, required training, and other health system mandated activities. Provides staff education to support change and ongoing development.
• Works independently, takes initiative, and thinks critically. Consistently demonstrates the ability to make appropriate judgments and decisions in carrying out daily job duties. Consistently demonstrates a commitment to excellence, willingness to seek feedback from staff and interactive listening skills. Gives high priority to quality outcomes.
• Responsible for reviewing and presenting the weekly DNFB report, collaborates with the involved departments to ensure the DNFB is worked timely.
• Audits claims submitted to Governmental and Non-Governmental payers to ensure compliance with all federal and managed care guidelines including, but not limited to, CCI edits, appropriate HCPCS/CPT/DRG, CAS/CARC/RARC codes, etc.
• Reviews the Medicare and Medicaid Credit Balance Reports to ensure refunds or adjustments are processed according to Governmental regulations and time frames, and reports credit balances quarterly to Medicare. Receives, researches, and responds expeditiously to questions/issues from Administration and/or Management. Keeps Management informed of important or unresolved issues as appropriate.
• Stays abreast of Governmental and Managed Care payer issues and regulations, modifications and notifications to advise staff and facilitate resolution of accounts. Attends training seminars as required, including completing CMS certification requirements on a yearly basis and ensure Governmental staff completes certification. Conducts regular staff meetings to ensure and encourage staff sharing of effective collection tools and payers’ concerns.
• In conjunction with the PFS Training Specialist, manages the quality and development program for existing and onboarding team members to assure assimilation to the team and promote a learning environment. Ensures that team preceptors and ambassadors are in place and knowledgeable of their responsibilities. Solicits feedback from preceptors and ambassadors to assure effective ongoing staff training.
• Adheres to hospital Talent/HR Policies and procedures related to coaching, counseling, interviewing, hiring and termination of team members.
• Actively participates in team development, developing dashboards and reporting to accomplish department goals and objectives through setting metrics and performing analytics to measure performance. Using a collaborative leadership style, facilitates the achievement of department and hospital-wide quality, safety, satisfaction and stewardship goals. Monitors and tracks data/reports as identified by the department leadership to achieve departmental or organization goals and metrics. Provides staff education to support changes and ongoing development.

Manager Capabilities

• Demonstrates accountability for overall departmental operations and/or organization-wide functional responsibilities within the system to support achievement of organizational priorities.
• Coaches team leaders, direct reports and team members to create a productive work environment.
• Creates a high performing team by building strong relationships, mobilizing others to action and effectively leveraging the talent of their team.
• Manages and supports conflict/issues resolution implementing appropriate corrective actions, improvement plans and regular performance evaluations.
• Demonstrates capacity to manage change resistance and break down barriers to effective improvement and transformation.
• Serves as a mentor for a healthy and safe culture to advance system, department and service experience.

Competencies & Skills

Essential:

• Excellent skills in communication and conflict resolution. Demonstrates tact, timeliness, coaching, accountability, commitment, leadership to achieve goals, ability to influence others and resource management. Communicates proactively to prevent problems and negotiates effectively to resolve conflict.
• Experience with Developing analytics to achieve goal-oriented metrics.
• Knowledge of collection policies and procedures, DRG’s and other billing or collections regulations and guidelines.
• Analytical report writing or analysis with emphasis in Medicaid and/or Medicare Governmental billing and follow up procedures. Knowledge of Medicaid, Medicare, and/or Governmental HMO billing and collections policies and procedures, DRG’s/CPT/HCPCS, HIPAA Regulations and other billing or collections regulations and guidelines.
• Proficient in Word, Excel, Internet navigation, Billing Systems (Cerner and Epic) or other office mainframe systems, E-mail, and other technology as required.
• Demonstrated knowledge of Talent/Human Resource policies and procedures related to employee coaching and counseling, as well as onboarding and precepting new employees.
• Demonstrate thorough knowledge of CMS, AHCA and all other payer rules and regulations, CPT and ICD-10 codes.

Qualifications & Experience

Essential: Associate Degree

Preferred: Bachelor Degree

Experience Essential:

- 3-5 years’ experience in a Hospital Inpatient and Outpatient Billing department and Cash Posting, including one year in Governmental follow up.

- Prior experience in a leadership role with Direct reporting responsibility and supervision of employees.

Experience Preferred:

- Previous Managerial experience in overseeing Commercial/Supplemental/Medicaid/Medicare Billing and Medicaid/Medicare governmental collections fields.