Performs coordination, monitoring, maintenance, updating of the Revenue Cycle’s Transplant cases in order to optimize gross and net revenue and ensure compliance with third party payer contracts and billing requirements. Ensures timely review of contract updates guidelines and implements necessary changes affecting the specialty billing team and proposes process improvements. Works closely with the clinical and administrative staff in specialty billing areas to ensure all patient accounts are handled in accordance with approved processes. Position works closely with the staff in various Clinical Departments, Patient Financial Services, Registration, Integrated Payment Posting, and Payors. Position ensures timely and accurate billing and collection of all specialty cases/claims in accordance with established policies.
Perform pre-transplant financial counseling services to patients including, discussion of benefits, financial concerns. Confirm patient insurance coverage including prior approval needs, obtain verify and update insurance, financial, statistical and demographic information.
Monitor incoming patient accounts ensuring accuracy in billing, collections and payment processing.
Investigate complex reimbursement issues pursuing appropriate actions to include statusing, adjustments, refunds, and transfers or billing third party payers.
Pursue collections of outstanding accounts ensuring not only that appropriate actions and decisions are made on the aged accounts but that all accounts with the patient are resolved.
Initiate adjustments, refunds, settlements and write-offs within established guidelines.
Respond to complex financial questions regarding patient accounts. Answer inquiries and resolve problems for patients, staff and payors including resolutions of disputed billings, liability transfers, and system programming issues.
Review changes made to transplant contracts, provide input to Contracting regarding operational, reimbursement and collection concerns.
Review of all regulatory and third party payer billing requirements to assess their impact on the transplant team activities and ensure such issues are disseminated to the appropriate hospital personnel. Coordinates with the Patient Accounting, Patient Financial Services, HIM/Coding Department’s and other internal customers to ensure that the billing is accurate and in compliance with regulatory and/or contractual guidelines.
Assist with development of analytical reporting to streamline data for use by internal and external customers.
Suggest and assist with implementation of reporting and other mechanisms to ensure efficiency and accuracy in the revenue cycle processes.
Assist in the development/revision of team policies and procedures.
Serve as a resource to UMHS departments, external payers regarding complex reimbursement issues and related operational issues.
Act as a liaison to the Hospital’s Compliance Committee, performing audits and working on projects as identified.
Perform random audits of charges to documented services and provide education to clinic staff, as necessary.
Establish and maintain positive working relationships with department administrators, revenue cycle staff, payors and all other customers.
Demonstrated knowledge of CMS regulations, medical terminology and the various data elements associated with the UB-04 and HCFA-1500 claim form.
Proficient in MiChart, Microsoft Word, Outlook, and Excel
Proficient and utilizes third party systems for claims tracking, authorization denial and payment review.
Demonstrates flexibility and manages change in a way that promotes productive performance.
Strong quantitative, analytical and organizational skills.
Initiate effective approaches to problem solving.
Possess thorough knowledge of online systems with ability to understand interfaces, data flow, work queue rules and system structure that have implications and impact on the daily work.
Organized, self-starter and detail oriented.
Ability to recognize trends or system problems and take appropriate action to resolve.
Strong decision making skills that effects immediate processing of all revenue cycle functions.
Excellent oral and written communication skills are required. Must exhibit excellent attendance.
Associate degree in business, finance or healthcare field with a minimum of five years experience in hospital billing, facility coding process and/or reimbursement experience, including familiarity with the functions and compliance concerns related to revenue cycle activities, or equivalents (combined) years of education and experience.
Demonstrates leadership qualities by employing integrity, team work, and ethical behavior.
Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.
The University of Michigan is an equal opportunity/affirmative action employer.
Internal Number: 179430
About University of Michigan - Ann Arbor
A great university is made so by its faculty and staff, and Michigan is recognized as one of the best universities to work for in the country. The Michigan culture is known for engaging faculty and staff in all facets of the university to create a workplace that is vibrant and stimulating.For two consecutive years, the Chronicle of Higher Education has placed U-M in its "Great Colleges to Work For" survey. In particular, the university earns high marks for strong relations between faculty and administrators, a collaborative system of governance, strong pay and benefits, and a healthy work/life balance.