Job Ref: 25260
Talent Area: Professional
Houston, TX 77054
Area/Department: Corp Rev Cycle - A/R
Employment Type: Regular
Job Type: Full-Time
Organization: Houston Methodist
Work Shift: DAY
Work Week: M - F
Houston Methodist (HM) is one of the nation’s leading health systems and academic medical centers. HM consists of 7 hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center and six community hospitals throughout the greater Houston metropolitan area. HM also includes a research institute, a global business division, numerous physician practices and several free standing emergency rooms and outpatient facilities. Overall, HM employs over 20,000 employees. FORBES magazine has placed Houston Methodist on its annual list of Best Employers in 2016. Houston Methodist is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide the best patient care and service in a spiritual environment.
The Manager of Commercial AR for the Centralized Business Office (CBO) is responsible for the entire collection process for a specific payor group. Specific payor groups include Blue Cross, United Health Care, Aetna/Cigna, Other, and Government Advantage. The insurance collection process includes initial payment, payment validation whether over or under paid, appeal/overturn denied claims, and credit balance resolution. The Manager will be responsible for key performance indicators including days in AR, AR greater than 90 days, cash collections compared to goal, denial recovery rate, avoidable write-offs, days in credit balance, and others.
PATIENT AGE GROUP SERVED
Select the applicable age group(s) of primary customers/patients served by this position.
Neonate (Birth to 28 days)
Infants/Toddlers (29 days to 18 months)
Toddler (18 months to 3 years)
Preschooler (3-6 years)
School Age (6-12 years)
Adolescence (12-18 years)
Young Adult (19-40 Years)
Middle Adult (40-65 Years)
Mature Adult (65 years and older)
HOUSTON METHODIST EXPERIENCE EXPECTATIONS
I. Provide personalized care and service by consistently demonstrating our I CARE values:
INTEGRITY: We are honest and ethical in all we say and do.
COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
ACCOUNTABILITY: We hold ourselves accountable for all our actions.
RESPECT: We treat every individual as a person of worth, dignity, and value.
EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.
II. Focuses on patient/customer safety
III. Delivers personalized service using HM Service Standards
IV. Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)
V. Intentionally rounds with patients/customers to ensure their needs are being met
VI. Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job
PRIMARY JOB RESPONSIBILITIES
Duties and Responsibilities are cross-referenced to the hospital¿s Pillars of Excellence and will be transferred to the Performance Evaluation.
1. Conducts periodic staff meetings to communicate results, new ideas, opportunities and training issues. Manager will champion departmental celebration where milestones and goals are met.
2. Communicates defined expectations which include weekly productivity, critical paths for non-routine issues, and service expectations. Will provide feedback/coaching/mentoring to staff and ensure staff is properly trained to be successful in meeting expectations.
1. Manage unit to assist in meeting key performance metrics set forth by leadership.
2. Manage vendors to ensure optimization of cash collections and minimize loss.
3. Analyze operations to avoid unnecessary denials and write-offs (financial).
4. Streamline operations to optimize efficiency and eliminate redundancy.
5. Analyze operations to decrease agings and to identify problematic activity.
6. Meet with payors regularly to discuss aged accounts, timely adjudication time frames and erroneous denials.
1. Implement assignments from idea phase to full implementation with minimal oversight and supervision from Director.
2. Partner with other CBO Managers to ensure consistency in execution of directives from Commercial Director.
3. Ensure the quality of the work performed by the staff including following defined work protocols, conformity with policies and procedures, and provides quality reviews.
4. Reports results of key performance metrics to Commercial Director on a timely basis.
5. Administers and monitors work standards, work flow and operating procedures as designated by Commercial Director.
1. Recognizes customer¿s needs and provides resolution in a timely manner.
2. Partner with other units in meeting their goals where processes intersect and/or overlap.
3. Provide Commercial Director with feedback on PAS and HIM issues to avoid denials and write-offs.
1. Seek ways to optimize cash collections and streamline operations throughout the CBO.
2. Provide automated solutions to manual processes or areas that typically need to be reworked.
3. Participate and present in Revenue Cycle forums. Become a subject matter expert in assigned area.
4. Attend local industry luncheons, seminars and actively seeks education in the healthcare sector.
This job description is not intended to be all inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.
Bachelor degree from an accredited college or University required. CPA or major in Accounting, Finance or other related business field is a plus.
5+ years of experience in hospital AR management, with a thorough understanding of billing, managed care reimbursement and collections. 4+ years of supervisory or management experience. Knowledge of Coding and front-end Patient Access processes and work flow are a strong plus.
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
Proven track record of effective management skills and driving desired results.
Skilled in coaching, mentoring, and developing staff.
Excellent written and verbal communication skills.
Ability to cultivate relationships and lead cross-functional teams within the Revenue Cycle.
Assertive while being even-tempered, pleasing personality and the ability to communicate easily with others.
Advanced Excel skills, including VLookup and pivot tables with the ability to manipulate large amounts of data.
Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security.
Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles.
Houston Methodist is an Equal Opportunity Employer.
Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.
VEVRAA Federal Contractor – priority referral Protected Veterans requested.