Req ID: 20452
Employment Status: AF - Active - Regular - Full Time
The Manager of Accounts Receivable Analysis requires a detailed understanding of billing / collections, contracts, governmental regulations and overall project management. This individual serves as lead management liaison to PARC and external third-party payors; is responsible for reporting and working to resolve reimbursement issues, communicating with and educating staff on billing procedures and other related concerns. Responsibilities include preparation for and conducting all monthly external/internal payor meetings to discuss obstacles in billing, claims, payments and receivables. Responsibilities also include communicating and meeting with peers of other billing departments to identify and address common issues. Individual will also assist with contract analysis and forecasting. This individual will need to conduct account receivable audits, and partner with the Revenue Cycle Manager to communicate findings and assist with developing work plans. Must be able to prioritize and work on several projects at once, work well with hospital, other CHOPPA departments, CAA billing staff, other divisional contacts, and have excellent communication and analytical skills; must possess the ability to manage people and processes.
Responsible for direct supervision of the Credentialing/Enrollment coordinator and Business Ops Analyst. Ensure maximum productivity and value is derived from these roles through accountability and follow through on assignments. Must have the ability to envision, develop, and structure analytical approaches. Must have the ability to critically think through questions and review of data. This individual will also assist with maintaining the EPIC fee schedule.
Will assist the Director and Revenue Cycle Manager in all aspects of departmental operations; will assist to oversee operations as needed.
The candidate will develop relationships with payors and internal customers alike, and interface with all levels of CHOP management.
The candidate will maintain responsibilities associated with time management, project coordination, process improvement, team building and goal assessment.
Conducts revenue cycle assessments and assists with the implementation of the process improvement recommendations .
Structures and conducts regular revenue cycle assessments/audits by payor or service on a weekly and monthly schedule, and as outlined in an annual operating plan. Assessments will be based on monthly reviews of standard reports (e.g., collection reports, aged A/R, credits, etc.) and issues collated by A/R staff as part of monthly collection efforts.
Supervises and directs the priorities of the Business Operations Analyst in routine and ad hoc reporting.
Oversees preparation of formal reports which will document revenue cycle assessment findings, identify opportunities for improvement, identify the responsible party or owner of each opportunity, and show financial metrics for all revenue related opportunities. Responsibilities include coordinating with Revenue cycle manager to identify improvements and additional audits/follow-up needed. Additional data review/assessments will need to be completed following investigation with AR Team.
Uses project management and process innovation methodology in all revenue cycle assessments and implementations.
Partners with clinical and administrative leaders in conducting and interpreting revenue cycle assessments whenever possible to promote a “shared vision” approach to potential changes.
Works towards meeting departmental goal of increased financial stability and growth by improving charge capture, coding, billing follow up procedures, efficiency of credentialing process and other related revenue cycle processes.
Third Party Payor Liaison for CAA:
Conducts pre-payor and payor meetings monthly.
Ensures appropriate follow up on all identified negative trends, including appropriate research, resolution with payors, and system modifications, as needed. Issues may include rejections, reimbursement trends, underpayments, overpayments, etc. Communicates issues to Revenue Cycle Manager for education and implementation within A/R team.
Maintains tracking log of all issues.
Performs root cause analyses and creates action plans; oversees implementation and monitor plan for successful incorporation into routine operations.
Oversees the implementation of corrective action plans via work in conjunction with Revenue Cycle Manager to track and resolve all known issues.
Maintains expertise in all third party reimbursement procedures, understands regulations, and reads all newsletters and updates with two working days of receipt. Must communicate these updates to the Finance Director and Revenue Cycle Manager in a timely manner. Responsible to ensure process changes are implemented as needed.
Job Responsibilities (Continued)
Billing Office Liaison to PARC for CAA:
Formulates a status report for each division.
Works with the Patient Revenue Cycle (PARC) representative to communicate all concerns identified by CAA Billing Office on issues that affect the timely submission of clean claims, and negatively affect cash collections or business processes (i.e. claim form issues, WQ changes, contract issues/changes etc.)
Maintains ongoing status log of all tickets and communicating status to Revenue Cycle manager. Collaborates with Revenue Cycle Manager to ensure issues are identified and addressed.
Directs enhancements to the EPIC system to automatically adjudicate payer specific logic that streamline AR management.
Addresses and assists the billing staff to resolve issues giving timely, appropriate feedback.
Communicates all PARC-related issues to the Finance Director and Revenue Cycle Manager on a weekly basis (e.g., delays in ticket resolution, payor plans, rejection subsystem payment codes, statement issues, etc.).
Supports the Revenue Cycle Manager in identifying trends which negatively impact AR.
Develops and maintains a working relationship with the Revenue Cycle Manager and other billing department management
Assists in identifying billing issues and develops systems and workflows to streamline the processes, increase clean claims, increase staff productivity, decrease error rates and increase reimbursement.
Analyzes reports such as, but not limited to: Collection rates and variances from budgeted collection rates, AR 3-month trend, Credit Balances, AR aged greater than 365 days; report findings and recommendations for process improvements.
Job Responsibilities (Continued)
Contract Analysis CAA:
Conducts contract analysis (open and closed AR) and payor analysis at the Department level for each payor as defined within the departmental fiscal year annual plan, or as requested by senior administration.
Provides senior administration with detailed financial analysis of new managed care and third party contracts, which includes analysis of fee schedules. Forecasts financial impact of potential contract terms on Department’s financial health.
Maintains the payor contract files by assuring communication involving policy and policy interpretation related to payment (verbal and written) is centrally located for reference and future contract negotiations.
Negotiates recommended settlements of underpaid accounts for approval by the Director of Finance.
Supervises and directs Credentialing Coordinator with the initial and re-enrollment process of new and existing physicians.
Intervenes with payors as needed to ensure the timely credentialing of physicians.
Ensures that the billing system and claims transmission processes and information are current.
Monitors and implements process for ensuring out of State Medicaid process and regulations are met. Coordinate with Revenue Cycle Manager and Billing Supervisor to communicate billing efforts to occur.
Departmental Operations Oversight
Assist with Special Projects as needed.
Works collaboratively within the Billing office management team to establish and achieve division and organizational goals and objectives.
Required Licenses, Certifications, Registrations
Required Education and Experience
Required Education: Bachelor’s Degree in Business or Healthcare Curriculum.
Preferred Education, Experience & Cert/Lic
Preferred Experience: At least seven (7) years of physician/hospital billing experience.
Additional Technical Requirements
Very strong analytical, computer skills required. Advanced knowledge of Microsoft Office Suite, especially Excel and PowerPoint; Strong capacity for data management. Advanced experience with Excel and/or database functions.
Familiarity with EPIC system preferred.
Ability to identify problems and find creative, effective solutions.
Understanding of complex insurance issues.
Excellent verbal and written communication skills.
Excellent interpersonal skills and phone etiquette.
Ability to serve as resource and liaison for multiple parties.
Ability to handle confidential materials.
Ability to handle multiple tasks and prioritize appropriately.
Excellent organizational skills and ability to meet deadlines.
All CHOP employees who work in a patient building or who provide patient care are required to receive an annual influenza vaccine unless they are granted a medical or religious exemption.
Children's Hospital of Philadelphia is committed to providing a safe and healthy environment for its patients, family members, visitors and employees. In an effort to achieve this goal, employment at Children's Hospital of Philadelphia, other than for positions with regularly scheduled hours in New Jersey, is contingent upon an attestation that the job applicant does not use tobacco products or nicotine in any form and a negative nicotine screen (the latter occurs after a job offer).
Children's Hospital of Philadelphia is an equal opportunity employer. We do not discriminate on the basis of race, color, gender, gender identity, sexual orientation, age, religion, national or ethnic origin, disability or protected veteran status.
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