Reporting directly to the Chief Financial Officer and working closely with the Chief Operating Officer, this position is responsible for all day-to-day billing and revenue cycle processes with special attention to billing outcomes and coding performance. This includes providing primary oversight of BCHP’s contracted revenue cycle management (RCM) provider and working closely with departmental staff and clinical providers to assure optimum billing performance. The following list of responsibilities is intended to describe the general nature and level of work to be performed in this position – it is not intended to be an exhaustive list of all duties, responsibilities and skills required.
Responsibilities include but are not limited to:
Responsible for entire pipeline of charge capture activities from encounter to correct coding, charging and collection of fees due; manage the day-to-day billing operations of the practice and ensure that the contracted RCM vendor is meeting all requirements of its agreement with the practice.
Analyze appeal reports, tracking work effort by the RCM vendor to ensure collections activity on a regular basis; analyze daily, weekly and monthly charge and payment data to ensure the RCM vendor is on track to meet established targets for productivity. Review EOBs as needed to determine/address payer problems.
Drive process improvement initiatives related to front end revenue cycle functions, in collaboration with the operations leadership and divisional managers.
Ensure that front-end systems and processes across all divisions and locations are designed and implemented appropriately to maximize customer service, staff efficiency and revenue capture. This may include systems and processes for registration, scheduling, check in / check out, referral management, point of service collections, and more.
Ensure timely entry of all charges, whether electronic or manual, and reconciliation of patient encounters to charges captured.
Coordinate professional coding of surgical procedures and implement and monitor appropriate processes to ensure timely receipt of operative reports and prompt coding and charging of such cases.
Work closely with the practice’s RCM vendor to ensure all denials are managed in a timely manner; analyze the root cause of such denials and implement corrective action plans as necessary.
Establish training standards for both new and existing employees and implement regularly scheduled classes; coordinate all necessary training when necessary for new software functionality or system upgrades.
Ensure that fee schedules and payor contracts are properly loaded into the PM software; establish and manage variance reporting processes and resolution of underpayments and overpayments.
Analyze daily, weekly and monthly reports presented by RCM vendor and identify opportunities for work process improvements; implement as necessary.
Oversee and provide input to the RCM vendor to ensure all systems are functional in categories such as dictionary files, data elements, interface and mapping, payer specificity, file transmission, billing area set, adding/deleting/updating ICD?10 and CPT codes, etc.
Coordinate and facilitate compliance audits; direct internal coding compliance reviews and provides feedback and education to providers and staff on coding errors.
Serve as a key resource for changes in payment and coding guidelines from all payors; educate and reeducate staff and providers on these continual updates and ensure that RCM system edits are updated as necessary to ensure clean claim submission.
Facilitate and influence the credentialing process managed by the RCM vendor to ensure prompt ability to bill for services rendered by providers; ensures tight processes are in place for both newly hired providers as well as providers in need of routine recredentialing.
Meet with senior leadership regularly to provide updates on the RCM vendor performance and overall revenue cycle health and make recommendations for organizational change, where necessary.
Perform other duties within the scope of the practice’s revenue cycle as may be assigned.
Certified Professional Coder highly desired but not required.
5?10 years related work experience with a minimum of five years’ supervisory/management experience required.
Strong Knowledge of professional billing practices and ICD?10 and CPT coding.
Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint and other applications. Ability to work with and produce complex documents and perform analyses
Decision Making: Ability to make decisions that are guided by precedents, policies and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area.
Problem Solving: Ability to address problems that are highly varied, complex and often non?recurring, requiring staff input, innovative, creative, and Lean diagnostic techniques to resolve issues.
Written Communications: Ability to communicate complex information in English effectively in writing to all levels of staff, management and external customers across functional areas.
Oral Communications: Ability to verbally communicate complex concepts in English and address sensitive situations, resolve conflicts, negotiate, motivate and persuade others.
Knowledge: Ability to demonstrate broad and comprehensive knowledge of theories, concepts, practices and policies with the ability to use them in complex and/or unprecedented situations across multiple functional areas.
Team Work: Ability to act as a team leader for projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.
Customer Service: Ability to lead operational initiatives to meet or exceed customer service standards and expectations across multiple areas in a timely and respectful manner.
MUST have own transportation and be willing to travel within the Hudson Valley region of New York and Fairfield County, Connecticut.
Ability to change work hours on an infrequent but as-needed basis.
Internal Number: 0001
About Boston Children's Health Physicians
Families throughout New York’s metropolitan area, the Hudson Valley, and Connecticut rely on the superior care they receive from Boston Children’s Health Physicians.
Expert, integrated care that’s close to home
We provide comprehensive care for newborns, children and adults — including diagnosis and treatment for a broad range of medical conditions — in more than 60 convenient locations. Locally, our practices are affiliated with New York Medical College and Maria Fareri Children’s Hospital.
Part of the Boston Children’s network of care
We are also proud to be part of the Boston Children’s Hospital network of care. Boston Children’s is ranked the #1 pediatric hospital in the nation, according to U.S. News & World Report. It’s one of the largest pediatric medical centers in the United States, offering a complete range of health care services for children of all ages.