Position Summary:

• Supervises day to day operations of the assigned work areas including identified patient accounts area to ensure the productive and timely submission and resolution of insurance and/or patient claims for all hospital and physician services with revenue integrity concerns. Serves as subject matter expert and primary go to person for staff level questions and education.

Essential Duties: 

• Directly oversees certified coders, revenue cycle staff, and revenue integrity staff and is responsible for ensuring their work output is satisfactory and their concerns are resolved.  This includes conducting routine staff audits for productivity and performance, tracking results, and coordinating training as appropriate.
• Leads work flow efforts for assigned area; overseeing, analyzing, prioritizing, reporting, reassigning and adjusting based on work needs including UH Revenue Integrity management and Service Catalog management and compliant billing workflows system wide
• Regulatory emphasis: researches and helps interpret regulations to problem solve issues, updates and manages  regulatory information including distribution of information to appropriate departments, analyzes local and entity enterprise changes as appropriate, lead for regulatory engagement with external agencies i.e. OHA
• Enterprise level effort standardization, centralization and optimization of charging processes
• Generates and analyzes reports for AR review and resolution; continually monitoring fluctuations in department goals/metrics.  In collaboration with manager, responsible for all hiring and related personnel decisions, completing routine performance review evaluations, training, scheduling, and process documentation.  Meets regularly with direct reports to review accomplishments and set goals.  Processes payroll and approves time off requests for direct reports. Identifies problem areas and develops plan of action to ensure benchmark standards are obtained and maintained.
• Participates in and leads payer and or departmental meetings. Responsible for providing feedback, suggestions and process improvement recommendations to manager and above. Performs and initiates special projects. Performs other duties as assigned.
• Revenue Impacts >$1 Billion

Position Summary:

• Supervises day to day operations of the assigned work areas including identified patient accounts area to ensure the productive and timely submission and resolution of insurance and/or patient claims for all hospital and physician services with revenue integrity concerns. Serves as subject matter expert and primary go to person for staff level questions and education.

Essential Duties: 

• Directly oversees certified coders, revenue cycle staff, and revenue integrity staff and is responsible for ensuring their work output is satisfactory and their concerns are resolved.  This includes conducting routine staff audits for productivity and performance, tracking results, and coordinating training as appropriate.
• Leads work flow efforts for assigned area; overseeing, analyzing, prioritizing, reporting, reassigning and adjusting based on work needs including UH Revenue Integrity management and Service Catalog management and compliant billing workflows system wide
• Regulatory emphasis: researches and helps interpret regulations to problem solve issues, updates and manages  regulatory information including distribution of information to appropriate departments, analyzes local and entity enterprise changes as appropriate, lead for regulatory engagement with external agencies i.e. OHA
• Enterprise level effort standardization, centralization and optimization of charging processes
• Generates and analyzes reports for AR review and resolution; continually monitoring fluctuations in department goals/metrics.  In collaboration with manager, responsible for all hiring and related personnel decisions, completing routine performance review evaluations, training, scheduling, and process documentation.  Meets regularly with direct reports to review accomplishments and set goals.  Processes payroll and approves time off requests for direct reports. Identifies problem areas and develops plan of action to ensure benchmark standards are obtained and maintained.
• Participates in and leads payer and or departmental meetings. Responsible for providing feedback, suggestions and process improvement recommendations to manager and above. Performs and initiates special projects. Performs other duties as assigned.
• Revenue Impacts >$1 Billion

Education:

• High school diploma or equivalent required.
• Bachelor’s degree in business or healthcare preferred.

Credentials, Licensure or Certification (i.e. RN, RRT):

CCS-P or CPC required

Experience & Knowledge:

• Minimum 3 years physician and/or hospital billing / accounting experience required.
• Minimum 3 years coding experience required
• Collection, billing and / or follow-up experience required.
• Supervisory experience preferred.
• Must have a strong working knowledge of claims submission & claims processing (UB-04s/HCFA1500, 837i and 837p) and third party payers.
• Working knowledge of ICD-9, ICD-10, CCI, LCD/NCD, and CPT required.