Provides analysis, consultation, and reports to the Director, Business Operations with a dotted line report to the Senior Director of Revenue Operations Physicians Billing Service (PBS). Reviews provider income data with department administration, Clinical Practice Association (CPA) and PBS management. Manages professional fee billing staff to ensure timely and consistent reimbursement for services. Interacts with physicians and their divisional managers to answer related questions and to clarify various billing concerns. Researches and resolves compliance issues. Performs abstract coding duties, as needed. Maintain strict confidentiality of staff and patient information. Will promote teamwork and identify areas of improvement and recommend coordinated actions to bring about changes.
Specific Duties & Responsibilities
Develops and monitors department group incentive plan targets. Analyze and present data for exceptions, if needed.
Provides assistance to the Department leadership and the Senior Director of Revenue Operations Physicians Billing Service (PBS) in the form of analysis, consultation, planning day-to-day management of the financial and administrative billing operation of the department.
Manages professional fee billing staff to ensure timely and consistent reimbursement for services rendered by clinicians from patients, insurance carriers, and/or state and federal agencies as appropriate.
Researches and resolves compliance issues and clarifies various billing concerns. Explains monthly service, income and rejection-analysis reports to department physicians, faculty, administration, Clinical Practice Association (CPA) and Physicians Billing Service (PBS) management.
Interfaces with third-party professional relations representatives to include Commercial, HMO, Medicare, Blue Shield and Medicaid. Meets periodically with representatives to discuss payment problems, coding compliance issues, and claim receipts.
Acts as departmental liaison with payers to stay current with changes in insurance requirements for several hundred payers, assuring that office procedures meet specifications for prompt payment.
Monitors charge and revenue budget variances and provides explanation to department Management.
Directs the development of billing policies and procedures for the departments’ professional fee billing offices consistent with, and complementary to, those already in place with the CPA.
Performs yearly reviews of encounter forms.
Monitors essential monthly reports to insure productivity, unit, core services and CPA objectives are met for their areas of responsibility.
Performs miscellaneous related duties as assigned.
Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
Holds coding certification and pursues additional training in Physical Rehabilitation Medicine coding. Proficient in surgical coding. Able to abstract code from operative notes, as needed.
Utilize online resources including EPIC, Compass and Cognos to facilitate efficient claims processing.
Requires a thorough understanding of medical billing and the unique customer service requirements as related to patients, physicians and administrative staff in a high volume medical services environment.
Professional and Personal Development:
Participate in on-going educational activities.
Assist in the training of staff.
Keep current of industry changes by reading assigned material on work related topics.
Complete three days of training annually.
Department Specific Responsibilities:
Functions as part of the departmental business operations team.
Works with Department leadership to identify key metrics and reports.
Updates and monitor department specific reports, as needed.
Pro-actively identifies provider billing issues (i.e., timeliness and quality of documentation, training issues, and recurring coding issues) and escalates to Department leadership and Senior Director for intervention, as needed. Works collaboratively to formulate action plans to address issues.
Pro-actively evaluates staffing levels and productivity of production unit and make recommendations to Department leadership and Senior Director, as needed.
Assists in investigation and resolution of patient complaints regarding professional fee billing.
Participates in departmental projects, as requested.
Attends review meetings with Department Director as required.
Orients all new faculty to billing processes and systems.
Serves as departmental compliance liaison.
Attends quarterly compliance review meetings.
Meets with all providers on a semi-annual basis.
Attends monthly managers’ meetings.
Adhere to Service Excellence Standards.
Continuous Performance Improvement.
High school diploma or GED. Bachelor’s degree in health care administration, business, or related discipline. 5 years progressive management responsibilities related to medical billing.
3 years supervisory experience required. Requires successful interpersonal and communication skills with patients, families, physicians, and other health care team members in order to foster optimal quality of outpatient.
Additional education may substitute for required experience and additional related experience may substitute for the required education, to the extent permitted by the JHU formula.
* JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience. Additional related experience may substitute for the required education on the same basis. For jobs where equivalency is permitted, up to two years of non-related college course work may be applied towards the total minimum education/experience required for the respective job. *
Progressively responsible professional level experience in a physician’s group practice or in an academic medical environment. Current CPC designation.
Special Knowledge, Skills, and Abilities
Strong analytical skills.
Excellent organizational skills.
Aptitude for figures and attention to detail.
Ability to interact effectively.
Capable of meeting deadlines and working well under pressure.
Knowledge of PCs and PC applications.
Excellent interpersonal, communication and customer service skills.
Knowledge of JHM and JHU/ PBS billing applications.
3-5 billing unit staff including certified coders and insurance follow up roles.
Classified Title: Production Unit Manager Working Title: Production Unit Manager Role/Level/Range: L/04/LC Starting Salary Range: $62,740 - $86,298, commensurate with experience Employee group: Full Time Schedule: Monday-Friday, 8:30am - 5:00pm, Up to 37.5 hrs/ week Exempt Status: Exempt Location: 04-MD:School of Medicine Campus Department name: 10003116-SOM PMR Production Unit Billing Personnel area: School of Medicine
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