MANAGER, PPO

Description

Under general direction of the Director, Revenue Cycle, the Manager, Patient Accounts manages the claim creation, billing and collection processes of his / her department.

Responsible for the development, implementation and monitoring of a program to ensure that claims are paid accurately and timely.

This position manages the day-to-day activities of his / her department in accordance with departmental and Hospital guidelines. Core Competencies

• Ensures selection, training, orientation and assignments of department staff; develops standards of performance and monitors and manages staff;
• evaluates performance and initiates or makes recommendations for personnel actions, promotions and disciplinary action; encourages professional development through in-service education;

develops and maintains job description for all staff members; resolves staff grievances.

• Maintains personnel records; approves CTO; and prepares work schedules for employees to provide adequate coverage for completion of required duties.
• Mediates staff conflicts and problems; documents and counsels performance problems; and promotes teamwork.
• Acts as a role model verbally and behaviorally.
• Attends meetings, as required, and participates in committees, as directed
• Acts as a liaison for the department with other Hospital departments, physicians, payors, patients, and patients' family members.
• Participates in Finance Division Hoshin goals by assisting the Director, Revenue Cycle in establishing goals for the department;

and assists staff in setting goals and meeting standards.

• Uses KPIs to manage and monitor revenue cycle operations, such as cash collections.
• Performs duties of department staff, as needed.
• Utilizes an effective internal tracking and documentation process to retain communications with and information received from Government entities that includes CMS, Fiscal Intermediaries, Carriers, and the OIG
• Participates in hospital performance improvement activities.
• Utilizes hospital computer system to update, adjust, and process accurate patient accounts.

Department Specific Competencies

• Develops, maintains and updates department policies and procedures; and develops and maintains training materials.
• Assists in developing, implementing and coordinating a Denial Management process to improve denial outcomes; gathers information that will correct the denial and prevent future denials;

and monitors regulations to ensure practices are current.

• Educates management and office staff regarding the way in which claims are paid.
• Works and assists staff in resolution of problem accounts.
• Performs claims audits periodically to ensure that claims are paid accurately.
• Monitors expenditures to ensure efficient use of resources to maintain budget.
• Ensures equipment meets specifications to maximize productivity.
• Assists in Disaster Drills, as needed, and follows Disaster protocols in the event of an emergency.
• Monitors work queues to ensure that claims are being processed timely.
• Maintains and follows-up on claims in medical review, claims holding various edit issues.
• Serves as the point person for true Self-Pay, non-capitates PPO / HMO and other commercial insurance patient accounts.
• Maintains the insurance master in Patient Accounting system.
• Maintains advanced knowledge of commercial payer requirements.
• Oversees the client billing process.
• Oversees the uninsured / underinsured allowance process.
• Attends meetings with outside providers / vendors regarding Revenue Cycle functions and processing of claims.

Education

Degree Program High School Diploma / GED or Higher EducationGeneral Studies

Experience

Number of Years Experience Type of Experience 5Billing and collection of PPO and HMO accounts

Additional Information Three or more years of supervisory experience in an acute care hospital with experience in admitting procedures / requirements, insurance billing procedures and requirements, patient accounting and collection procedures and electronic remittance advice and payment posting requirements.

Compensation Range

$82,000 - $133,000 / Annually