GENERAL SUMMARY: Supervises and coordinates work assignments related to back-end billing functions, including facility third-party payer billing, insurance, and self-pay follow-up, cash operations, and denial management. Plans, controls, and implements departmental policies and procedures to affect the orderly flow of accounts from Discharge Not Billed (DNB) to payment in full. Participates in quality assessment and continuous quality improvement activities. Performs all job duties and responsibilities in a courteous and customer-focused manner according to the Hurley Family Standards of Behavior.

SUPERVISION RECEIVED: Works under the general supervision of the departmental director or designee who assigns and checks work for conformance with established policies and procedures.

SUPERVISION EXERCISED: Exercises full supervision over personnel engaged in billing, collections, cash posting, and activities and maintenance of related work records.

MINIMUM ENTRANCE REQUIREMENTS:

• Associate's degree in Business Administration or related field and three (3) years of experience in one or combination of the following areas (additional experience, as described may be substituted for required education on a year-for-year basis):
  • inpatient and/or outpatient electronic claims processing
  • UB-04 billing procedures for third-party carriers in a hospital setting
  • credit, collections, and patient accounting in a financial or medical care setting, involving work with external collection agencies and/or counseling on credit assistance
• Knowledge of inpatient and outpatient billing procedures for third party carriers and managed care.
• Knowledge of medical terminology and procedures as related to hospital billing codes.
• Knowledge of electronic and UB-04 computerized billing systems NUBC guidelines and inpatient/outpatient hospital reimbursement methodology.
• Knowledge of Fair Debt Collection practices and collection laws of the State of Michigan.
• Knowledge of Federal and State laws regarding dissemination of patient medical and billing information.
• Ability to establish and maintain effective working relationships exercising courtesy and tact with physicians, patients, medical center staff, outside agencies, and the general public.

PREFERRED QUALIFICATIONS:

• Working knowledge of Epic Revenue Cycle applications: Resolute Hospital Billing, Resolute Professional Billing, Cadence, Grand Central or Single Business Office.

1. Supervises, coordinates, and participates in regular, ongoing revenue cycle operation activities for assigned patient financial services area. Ensures activities are in accordance with medical center policies, third party payer mandates, and statutory laws.
2. Develops staffing and work schedules for in-office, hybrid, and remote personnel. Approves leaves, vacations, personal days, and overtime. Accurately computes and initiates payroll data.
3. Interviews, hires, evaluates, disciplines, and, when necessary, recommends discharge of staff. Completes performance reviews in timely manner. Answers grievances at first step. Completes time management reports and provides employee productivity feedback in timely and consistent manner.
4. Identifies, plans, and assists in orientation, training, and in-service/continuing education. Assists with identifying training needs and coordinates with the department trainer to develop and conduct training programs, including on-the-job training.
5. In coordination with departmental managers, plans goals and objectives to accomplish agreed upon departmental goals in areas of responsibility. Plans and implements systems and procedures for goal attainment. Promotes and supports processes, programs, and methods to enhance the quality of service.
6. Coordinates and facilitates team meetings. Ensures meeting notes are thorough and complete. Provides information for and coordinates special projects/activities within the area assigned.
7. Maintains efficient billing flow, productivity, and customer satisfaction standards. Troubleshoots and resolves computer-related problems.
8. Monitors accounts and initiates prompt follow-up action on aged AR to third parties. Actively reduces the time span from services provided to the date paid. Proactively monitors denials and escalates denial trends to revenue cycle leadership, payers, and departments. Reviews denial data, performs root cause analysis and recommends system and/or workflow optimization.
9. Coordinates and manages receivables to assure that all accounts have appropriate (in compliance) billing and collection activity according to standards outlined in Hurley Standard Practices, insurance contracts, HMO contracts, or federal/state regulations.
10. Supervises preparation of departmental reports, records, and statistics. Computes and maintains departmental reports including management reports regarding productivity and performance standards.
11. Confers with departmental managers and supervisors to resolve accounts with outstanding balances, to understand the cause of account adjustments prior to approval, and to improve issues related to self-pay or managed care, such as charity care, ineligibility, and invalid/absent authorizations/referrals. Identifies and resolves problems relating to charge capture and late charges.
12. Makes recommendations for system process improvements by actively monitoring billing and reimbursement activities. Communicates recommended changes by providing thorough, complete, and sufficient information and supporting documentation to maintain or improve billing and reimbursement efficiency.
13. Meets regularly with third party payer representatives or vendors to present and resolve reimbursement, billing, and claim issues as well as communicates departmental objectives as necessary.
14. Coordinates, monitors, refers, and recommends legal action/activity for uncollectible or aged accounts, bankruptcy proceedings, liens, and estates with Financial Counselors, legal collection specialists, revenue cycle attorneys, or external collection agencies as appropriate and necessary.
15. Performs other related duties as required. Utilizes new improvements and/or technology that relate to job assignment.