The incumbent oversees the daily operations of the medical office consistent with good business practices and in conformance to overall institutional practices, including personnel management, financials, budgets, accounts payable, accounts receivable, payroll and purchasing. Must be a leader, team player and able to work with a multidisciplinary team of physicians and others in the practice. Must possess the ability to manage multiple tasks simultaneously and be able to compensate for staffing requirements as needed. Must be highly skilled with computer systems used by both physician offices and hospitals to capture data accurately and consistently to permit an appropriate claim for payment to be completed as well as to appropriately capture other needed information. An excellent understanding of physician office practices systems, including medical records, compliance requirements with respect to coding, documentation, billing, collections, personnel management, insurance plans, is essential.
MINIMUM QUALIFICATIONS :
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. High School Diploma or equivalent.
EXPERIENCE:
1. Three (3) years current management experience in a physician practice setting, where management of individuals, computer systems, purchasing, accounts payable, accounts receivable, billing, coding, scheduling, governmental or insurance regulations and requirements.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an exhaustive list of all responsibilities and duties. Other duties may be assigned.
1. Maintains department Policy and Procedure Manual accurately describing all operating procedures.
2. Provides positive leadership and builds an atmosphere of teamwork, cooperation and high professional standards at all times.
3. Assures all hospital policies are implemented and followed,
4. Establishes fair dealing with community groups, state agencies, customers, physicians and general public.
5. Cooperates with the Administrator to ensure clinical documentation, procedures and protocols are in place, audited and documented on an ongoing basis.
6. Regularly measures and monitors patient and physician customers in order to establish performance improvement objectives and standards and on effective patient complaint program.
7. Ensures effective infection control and safety programs are maintained.
8. Manages technical and clinical work systems to ensure quality patient care.
9. Manages an effective electronic medical record and documentation program.
10. Resolves patient and interdepartmental complaints and misunderstandings in a timely manner. Consistently investigates and takes corrective action necessary to resolve problems and complaints regarding department procedures.
11. Assures quality patient care is provided consistent with hospital policies and JACHO requirements.
12. Ensures proper maintenance of facility building and grounds through supervision of preventive and corrective maintenance programs consistent with hospital policies.
13. Evaluate and recommend solutions in resolving accounting discrepancies in the Business office.
14. Responsible for maintaining and managing a registration system that coordinates patients arrival, complete registration, third party and patient credit reviews, consents for treatments, and counseling patients about their payment responsibilities.
15. Reviews write-off listing, refund requests, miscellaneous cash adjustments for potential policy problems.
16. Demonstrates a thorough knowledge of the job descriptions and key requirements for each position in all areas, instructs others in the performance duties, holds associates accountable at all times for the responsibilities within their positions.
17. Monitors the timeliness and quality of all phases of the registration and collection process. Makes changes as appropriate.
18. Oversees and manages accurate and efficient precertification /authorization process.
19. Implements and supervises an effective billing and coding program consistent with hospital policies in regard to compliance and sound business procedures for physicians and /or extenders.
20. Implements and supervises an effective information system necessary to support the billing system.
21. Implements appropriate cash management, purchasing, and other accounting procedures in close cooperation with the hospital Controller.
22. Prepares and maintains operating and capital budgets in conjunction with the Administrator.
23. Maintains a record retention program in accordance with hospital and external third party requirements. Consistently is attentive to record keeping and documentation of patient accounting activity and other record maintenance requirements inherent to the patient accounting function.
24. Develops goals and objectives for cash collections and monitors compliance with payment and charity care policies.
25. Manages accurate payment posting process.
26. Ensures department compliance with Joint Commission Rules and Regulations.
27. Responsible for implementing compliance to CMS (Centers for Medicare Services) regulations, Medicaid, and PEIA with reference to adequate documentation in support of an appropriate statement submitted to a Governmental agency for reimbursement, consistent with hospital policies and procedures and CMS guidelines.
28. Assure that all CPT and ICD-9 Codes are entered accurately into the computer system as they are updated yearly.
29. Maintains compliance with OIG regulations.
30. Manage all physician an non-physician credentialing and re-credentialing with insurance companies.
31. In cooperation with the physicians, ensures clinical documentation, procedures, and protocols are in place and audited.
32. Implements effective scheduling and staffing programs.
33. Maintains an effective communication program and encourages staff involvement in decision-making and problem solving.
34. Completes all performance evaluations in a timely manner and counsels/coaches associates as appropriate.
35. Completes time cards (Kronos) for assigned associates.
36. Assures all clinical documentation is accurate and correct and when issues are discovered educates and disciplines as necessary.
37. Create and maintain clinical and clerical policies and procedures and audits to assure compliance.
38. Participate with Safety manager to assure appropriate disaster preparedness program and safety program.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping, and feeling are necessary body movements utilized in performing duties throughout the work shift.
2. Must have excellent hearing ability.
3. Visual acuity (corrected) – Keen for both distant and near objects/individuals (i.e. ability to read small print).
4. Must be able to read and write legibly in English.
5. Must be able to perform heavy work: exerting in excess of 100 pounds of force occasionally, and/or up to 50 pounds of force frequently, and/or up to 20 pounds of force constantly to move objects.
6. Must have reading and comprehension ability.
7. Must have the ability to move freely through the facility to perform daily and special tasks.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Working closely with others
2. Normal office setting with electrical equipment (i.e. telephone, personal computer, copier, fax machine, etc.)
3. Computer Software/Systems include but are not limited to:
- Microsoft Office Professional Suite (Outlook, Word, Excel, Access)
- Patient Information System
SKILLS AND ABILITIES:
1. Ability to type 25 wpm preferred.
2. Possesses the interpersonal skills to positively and effectively communicate, negotiate, and resolve conflict.
3. Cooperatively interacts with the health care team to support and contribute to the shared group goals.
4. Knowledge, by experience, testing, or academic course work completion of CPT, ICD-9, HCPCs, coding for purposes of being able to abstract office medical record information in order to generate a claim submission for payment by a third party payor and/or patient is required.
5. Documented knowledge of claims management and collection processes in a physician practice is required.
6. Knowledge of third party payor requirements, contracts, and authorization and payment practices required.
Additional Job Description:
Scheduled Weekly Hours:
40
Shift:
Exempt/Non-Exempt:
United States of America (Exempt)
Company:
PCH Princeton Community Hospital
Cost Center:
8040 PCH Family Medicine
Address:
118 12th Street
Princeton
West Virginia
Equal Opportunity Employer
West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.
