Job Ref: 26920
Talent Area: Professional
Houston Methodist Specialty Physician Group
Houston, TX 77030
Area/Department: EPIC-A/R General
Employment Type: Regular
Job Type: Full-Time
Organization: Houston Methodist
Work Shift: DAY
Work Week: M - F
Houston Methodist Specialty Physician Group - As one of the nation’s leading hospitals and academic medical centers Houston Methodist has brought together some of the nation’s leading experts in multiple specialties to serve our patients. As part of Houston Methodist Specialty Physician Group (HMSPG), these specialists not only provide excellent clinical care, but are on the forefront of research, developing leading-edge technologies and treatments, and teaching the medical pioneers of tomorrow. This combination of clinical service, research and academics ensures patients have access to the latest in treatments and technologies while providing the best in comprehensive patient care. Established as a non-profit corporation and certified by the Texas State Board of Medical Examiners, HMSPG enables physicians to maintain autonomy with respect to their clinical practice while growing their practice within an academic environment.
The Manager is responsible for overseeing revenue cycle activities to ensure consistent fiscal performance and achievement of specific departmental standards and goals. The Manager oversees the supervisory staff to ensure stated goals are met through the following processes: claim submission, payor follow-up, denial review, appeal submission and adjudication. The Manager is also responsible for monitoring and improving all revenue cycle metrics and measures, including but not limited to the following: AR days, aged AR, cash collections, denials, avoidable write-offs, staff productivity and work quality, credit balances.
System and department specific ICARE 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.
DUTIES AND RESPONSIBILITIES
- Responsible for the direction and coordination of several centralized business office operations related to the processing and adjudication of professional services claims to insurance
- Manages employee day-to-day transactions and processes
- Accountable for ongoing professional growth and development of the supervisory staff
- Partners with other managers in the execution of directives from the PO CBO Director
- Coaches, motivates, develops and provides guidance to direct reports
- Maintains timekeeping and coordinate all time activities
- Ensures that insurance follow-up efforts result in optimal reimbursement
- Gathers and analyzes financial information regarding charges, payments and AR
- Interprets and/or evaluates information and/or create analytical approaches
- Analyzes operations to identify problematic activity impacting AR agings, denials, and write-offs for departments and physicians
- Initiates revenue enhancement projects and special projects as a result of ongoing revenue cycle analysis
- Meets with payors to discuss aged accounts, timely adjudication timeframes and erroneous denials
- Collaborates with the Client Service Managers to analyze department operational impact on revenue resulting in optimal and timely revenue
- Establishes policies and procedures according to provider organization¿s standards and legal requirements
- Conducts formal performance reviews and provides feedback to team members.
- Works with team members to improve, track, and develop areas of poor performance
- Administers and monitors work standards, work flow and operating procedures as designated by the PO CBO Director
- Stays informed of the latest department, Medicare, Medicaid and commercial payor news, updates, and regulations and adjust processes and procedures based on the changes with support from the PO CBO Director
- Ensures the protection of private health and personal information. Adhere to all HIPAA and PCI compliance regulations.
- Demonstrates and supports the Houston Methodist vision, mission and ICARE values statement
- Participates in and ensures compliance within regulatory and Houston Methodist policies, practices and standards; coordinate training opportunities as needed
- Develops new ideas resulting in major improvements to existing methods, services, processes and/or procedures
- Identifies opportunities for the development and implementation of new solutions or exceed customer/patient needs
- Seeks new and creative technologies that help identify and guide improvement opportunities that align with overall PO CBO success
5 years of managerial experience required in medical billing and insurance collections
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
- Proficient in computer accounting programs, Microsoft Excel, medical terminology, basic coding knowledge and medical billing systems
- Establishes and maintain effective working relationships with other employees, patients, organizations and external customers
- Ability to develop, implement and produce complex reports
- Ability to motivate and create a team environment, prioritize work distribution, exceptional organizational and time management skills
- Strong communication (verbal and written), organizational, problem solving and team player skills
- Excellent project management skills. Must be able to manage multiple projects.
- Ability to navigate across multiple customer demands and balance competing priorities successfully
- Ability to analyze, identify and articulate identified trends and report trends succinctly in a clear and concise manner
- Ability to focus on problem or task and articulate a resolution in a prompt, productive and efficient manner. Recognizes, evaluates, solves problems and corrects errors.
- Maintains confidentiality of sensitive information
- Independent action and judgment is required, subject of general business-wide policies
- Requires strong leadership skills with the ability to coach and develop staff
- Analytical and critical thinking skills required
- Ability to think critically and identify the global impact across the revenue cycle with a solution oriented approach
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.