Provider-Based Business Office Manager

 

Job Summary

The Provider-Based Business Office Manager will be responsible for managing the Provider-Based Business Office department. The Manager will develop, monitor, evaluate, and implement methods to maximize efficiency and compliance related to coding, billing, accounts receivable, and reimbursement processes and procedures.

 

Job Requirements

Education:

·         High School Diploma or equivalent required.

·         A Bachelor of Science degree in business or healthcare-related field of study is preferred.

Licensure:

·         Coding Certification required.

·         Registered Health Information Technician/Administrator (RHIT/RHIA) is preferred.

Work Experience:

·         A qualified candidate should have five years of relevant experience.

·         Requires advanced knowledge of ICD-10-CM; ICD-10-PCS; CPT-4; and HCPCS coding systems.

 

Essential Functions

·         Responsible for regulatory adherence. Ensures all coding and billing practices comply with federal, state, and local regulations, including Medicare, Medicaid, and private payer guidelines.

·         Identifies, communicates, and ensures that staff meet productivity, timeliness, and quality standards to support the financial goals of the organization.

·         Serves as the primary liaison position between the clinics and the Business Office for the clinical documentation required to accurately and completely document the level of patient care provided, to support data collection/utilization and assignment of diagnosis and procedure codes.

·         Ensures that documentation and coding practices meet National practice guidelines and the compliance goals of the organization, managing State and Federal regulatory and other monitoring agencies as well as private carrier requirements, external audit and the Kentucky State reporting functions.

·         Provides guidance and motivation to staff regarding identifying activities/areas where performance can be improved.

·         Actively participates in setting, monitoring and achieving goals for the team.

·         Provides oversight to the ongoing operation or selection of electronic coding or documentation improvement software, interfaces with billing systems and workflow changes with computerized patient information.

·         Coordinates and provides the necessary educational programs for Billing, Coding and Clinical Documentation staff.

·         Ensures that extracted data is tracked, trended and translated into actionable outcomes.

·         Manages the un-coded by ensuring prompt query responses concurrently.

·         Serves as liaison for organizational departments requiring assistance with coding of accounts and/or information about coding and/or documentation.

·         Assists Patient Financial Services with claims processing as needed.

·         Interacts with other JSMC Departments to assist with correct interpretation and response to queries.

·         Responsible for audit planning and execution. Develops comprehensive audit plans to review coding and billing practices. Responds to external audit inquiries and findings as appropriate.

·         Creates and monitors outpatient services mix reports and the leading medical visit, surgical service, significant procedure, and ancillary APC's assigned in the facility to identify patterns, trends, and variations in the facility's frequently assigned APC Groups.

·         Establishes departmental objectives and works with staff to set individual goals

·         Develops, reviews, and revises policies and procedures to maintain the efficacy of the department

·         Communicates any operational changes and/or improvement initiatives to staff

·         Oversees training practices; provides education and training as needed

·         Develops effective decision-making, communications, and interpersonal relations to ensure a positive image of Jennie Stuart Health and to ensure customer satisfaction

·         Provides timely and professional follow-up to customer complaints and issues

·         Ensures problem resolution and corrective action for long-term solution, coordinating such effort across intra and inter-departmental channels

·         Provides function-specific training, including staff orientation/onboarding and continuing education

·         Reviews employees work regularly, discusses problem areas, and maintains periodic documentation as needed. Makes recommendations regarding personnel actions and follows-up as warranted.

·         Mentors and coaches personnel to ensure positive outcomes

·         Manages the work schedule, ensuring adequate and appropriate coverage and performance

·         Responsible for employee corrective action with direction from department Director

·         Provides input documentation to employee's performance during orientation and annual reviews

·         Maintains fiscal accountability for assigned area of responsibility by identifying new operational, capital and program needs, monitoring staffing allocation in alignment with customer service goals, and by meeting budget parameters

·         Analyzes and displays data in meaningful formats

·         Establishes key performance indicators

·         Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Jennie Stuart Health's policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior

·         Serves as relief support and a "super user" for new programs, processes, and technologies

·         Maintains and reviews benchmark data

·         Monitors to identify delays to billing and will report encounters at risk for timely filing

·         Performs other projects and duties as assigned