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JOB SUMMARY :
This position is responsible for managing Revenue Integrity Analyst and Denials Manager positions. They will manage all tools as they relate to revenue integrity.
They are also responsible for CDM management, audit process and denials improvement processes.
This position is responsible for managing of the billing in Patient Financial Services in such a manner as to generate claims / bills which meet payor specifications, to collect timely payments on such claims / billings, and to effectively administer accounts receivable, and to provide a high-level of customer satisfaction, all within the confines of laws, rules and regulations.
Management of all SSI products to ensure proper utilization and training when necessary.
REPORTS TO :
JOB SPECIFIC RESPONSIBILITIES :
Identify revenue cycle problems, research / analyze data to resolve issues, identify and select
alternatives, and implement solutions for improvement. Provide revenue capture training as
needed, especially when issues arise.
- Review departmental revenues monthly and assist with revenue variance meetings.
- Work with IT to implement automated charge capture across the hospital and provide support
for each go-live. Monitor and correct charge issues that result.
- Oversee the annual charge reviews with revenue departments.
- Execute the annual pricing study and monitor revenues resulting from price changes.
- Respond timely to e-mail and phone requests made by employees of Patient Financial Services
and all other departments.
Supervise and coordinate the activities of the Revenue Integrity employees including charge
creation and capture, audits, denials, etc.
Evaluate staff performance and provide timely and factual feedback as necessary. Complete
performance appraisals according to hospital policy.
Keep Director and administrators regularly informed of issues, recommendations for
improvement, and ongoing operation events.
Understand claim queue processing relating to networking between IDX and SSI, processing
claim queues and importing claims into SSI across UMC network. Coordinates hardware support
with IT department.
Communicates effectively with the Revenue Integrity Department to assure correctness of
CPT / HCPCS coding in charge master.
Demonstrates a high level of understanding relating to how SSI translates claims into SSI and
transmitting claims to payor groups.
- Monitors balance sheet to ensure all electronic claims are received by payers.
- Monitors carrier claim rejections and implements steps necessary to prevent future claims
rejections. This includes management of Hold Bills to assure proper billing.
Maintain claims forms for accuracy according to the payer specifications. Both the electronic
and paper claims.
Assist any employee within Patient Financial Services with any problems, issues or concerns on
a daily basis.
EDUCATION AND EXPERIENCE :
- College degree in business related field or equivalent experience
- Supervisory skills
- Medical and insurance terminology
REQUIRED LICENSURES / CERTIFICATIONS / REGISTRATIONS :
None required.
SKILLS AND ABILITIES :
- Ability to communicate both verbally and in writing
- Mainframe computer skills
- Basic accounting and detailed clerical skills
- Possess customer relation skills
- Highly technical and problem-solving skills
- Ability to adapt to changes
INTERACTION WITH OTHER DEPARTMENTS AND OTHER RELATIONSHIPS :
Constant interaction is required with Admitting, Utilization Review, Fiscal Administration, Resource Assistance, Health Information Systems and Information Technology.
Frequent interaction is required with all revenue generating departments. Interaction with other departments shall occur as needed.
PHYSICAL CAPABILITIES :
Work is of medium demand; walking, sitting and standing most of the time while on-duty. Occasional lifting of equipment is required.
Adequate hand / eye coordination and fine motor skills required for typing. Talking and hearing is essential in dealing with co-workers and customers.
ENVIRONMENTAL / WORKING CONDITIONS :
Work in a well-lighted, heated and ventilated building. Hours may vary to accommodate needs of other departments.
DIRECT REPORTS :
UMC Health System provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
- Request for accommodations in the hire process should be directed to UMC Human Resources. *
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