The Senior Manager of Billing & Collections reports directly to the Director of Clinical Finance and is responsible for the billing and collection activities related to self-pay and insurance accounts receivable. This position directly supervises the Billing and Claims Manager and associated financial coordinators responsible for claims submission, payment processing, denial management, collections, and other financial responsibilities related to insurance programs. Also, this position directly supervises the Collections Specialist responsible for patient-related billing and the management of the associated accounts receivable. As such, the Senior Manager of Billing & Collections is responsible for developing measurable criteria to evaluate staff performance and monitoring progress, taking corrective action(s) where necessary to ensure efficient and effective operations, providing periodic updates to the Director of Clinical Finance. Ensure that the clinical finance department is operating efficiently and effectively by monitoring the progress of direct reports, including establishing measurable outcomes, periodically running reports to determine where corrective action plans are necessary. Further, providing periodic updates to the Director of Clinical Finance on these outcomes as well as assessment of departmental needs. This portion of the role is imperative as the Senior Manager is expected to act independently, providing updates to or asking for guidance from the Director of Clinical Finance when support is needed. It may also include the need to step in and resolve issues that cannot be resolved directly by the staff.
Oversee all aspects of BUGSDMs participation with insurance companies, including:
serving as a liaison;
researching additional programs for which BUGSDM may qualify to participate;
aiding the Director of Clinical Finance in developing and maintaining relationships with the participating programs;
managing the entire claim submission and payment process for these programs;
establish and manage claim denial prevention process;
developing dashboards and monitoring these metrics to ensure optimized financial operations are in place. Collaborate with the Director of Clinical Finance, Director of Clinical Operations, and other stakeholders for development and implementation of policies and procedures to maximize revenue and optimize collections.
documenting policies and procedures;
communicating the policies and procedures to stakeholders;
developing training materials to assist in the successful implementation of the policies and procedures; identifying methods for enforcing these polices and procedures; and
identify and develop measures to ensure effectiveness of policies and procedures. Other duties as needed by the Director of Clinical Finance, including participation on special projects.
Candidate must have thorough knowledge of the insurance billing process, including claims creation, industry charge codes, documentation required for timely filing of claims, processes to resolve denied claims, appropriate adjustment of fees based on insurance contracts, and final resolution of claims and payment.
Candidate must also have knowledge of credit and collection procedures and methodology, computerized billing procedures, and all types of insurance plans and policies (Mass Health, BCBS, Delta Dental, etc.).
Internal Number: 3434
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