This position will serve all EMHS Member Organizations through detailed analytical review of data to drive process improvement, mitigate risks, impact to reimbursement and recommend solutions. This position will perform root cause analysis with claims, denial, payment and adjustment files leveraging our data for all of EMHS to investigate and identify trends. This position will need to interpret insurance payor policies and contracts to ensure that our findings meet the regulatory guidelines. This position is responsible for handling highly sensitive and confidential information, will regularly exercise discretion and judgment, possess excellent project management and analytical skills, is knowledgeable about business and financial matters applicable to the healthcare industry, will possess verbal and mental acuity consistent with the demands of the job. This position requires excellent time management skills and the ability to reprioritize assignments on an ongoing basis. This position will initiate, follow through and complete projects as assigned. Accurate and timely communication with internal and external customers is required. This is a fast paced position with significant interruptions. A positive and supportive attitude and the ability to refocus on the task at hand in a timely fashion is a must. This position will support management of projects, vendor and payer relationships and work closely with all levels of the EMHS Patient Account Services in the Centralized Business Office. Knowledge of Claims, AR Resolution, Customer Service, Denials, Contracts, Cash Reconciliation, Credits, Adjustments, Insurance payments and other CBO functions are necessary to perform in this role. This position requires a thorough understanding of the requirements of the Government and Non-Government payment processing policies. In addition, this position is held accountable to adhere to the policies, procedures, and applicable laws.
Education and Experience
•Bachelor's Degree and (1) one year of general revenue cycle experience OR Associates Degree and (2) two years of healthcare specific revenue cycle experience OR High School diploma and (8) years healthcare specific revenue cycle experience.
•Degree in business, finance or healthcare administration preferred. Required Minimum Knowledge, Skills and Abilities
•Detailed knowledge of billing and payment rules and regulations in a healthcare setting (Government and/or non-Government payers); multiple hospitals/physician practices preferred.
•Knowledge of medical terminology, Current Procedural Terminology (CPT), and International Classification of Disease (ICD) preferred.
•Experience with EMHS patient accounting software is preferred.
•Must possess strong problem solving skills.
•Ensures all AR resolution functions performed are compliant with applicable laws and regulations.
•Excellent professional communication skills; both oral and written.
•Ability to understand payer processing policies and all applicable billing rules and regulations to facilitate decision making.
•Proficient with Microsoft business applications.
•Strong customer service skills
•Demonstrated ability to work independently and collaboratively. Essential FunctionsPeople
•Actively participate in team huddles and meetings by way of sharing knowledge, requesting information, and recommending process improvements.Service
•Work closely by way of problem solving with peers and leaders to address issues or changes that directly impact the accounts receivable.
•Prioritizes work according to the needs of the Department Directors
•Coordinate project management activities (i.e. BLMR/AMR, AR Operations Workgroup, Insurance Payer Meetings)
•Coordinate AR Operations Support Meetings: Facilitate meetings, with prepared agendas, system ticket management, provide analytical support, minutes and tracks follow up tasks as assigned to maintain continuity, manage the white space between meetings and progress towards the desired EMHS outcomes.
•Coordinates special projects/reports as assigned, manages project from beginning to end, and provides periodic progress updates.
•Provide coverage for critical tasks as needed Quality
•Manage CBO projects as assigned: utilizing technology and healthcare business expertise to perform business and systems analysis of EMHS data to identify opportunities, risks and aid us as a system to make decisions on best practices relating to areas such as workflow and system enhancements. Ensure proper testing and validations have occurred and documentation exists for all aspects of the project. Identify project barriers and escalate issues timely to manager or department director. Develop new/updated policies and procedures prior to implementing any new practices.
•Create and maintain project documentation, schedules, action plans, data analysis, reports and resourcesFinance
•Vendor performance: analyze and track vendor performance and report results monthly. Identify areas of risk or opportunity and escalate to manager or department. Make recommendations to improve, maximize, limit, or terminate vendor relationship based on project outcomes.
•Payer Management: Provide analytical support for payer meetings. Maintain payer score cards. Develop agenda and facilitate payer meetings which will include payers and EMHS CBO and Non-CBO facilities. Opening tickets as appropriate, maintaining meeting minutes and communication with all involved parties to ensure that deadlines are met.
•Denials Analytics and Management: Identify and track denial trends by location. Work with Administrative and Clinical Practice Managers teams to develop corrective actions and monitor performance.
•Facilitate the process of compiling and distributing monthly accounts receivable highlight packages to finance leadership teams.
•Preparing monthly AR reports for the Management Team
•Developing and maintaining the AR KPI Tool to measure success (i.e. AR SnapShot)
•Thorough understanding the department's Key Performance Indicators.Growth
•Maintain the knowledge of Accounts Receivables in compliance with policies, regulations, procedures and standards.
•Participate in monthly Payer Meetings
•Attend internal education sessions to enhance or gain new skills.
•Certified Revenue Cycle Professional certificate within two years of employment.Community
•Demonstrate departmental desire to provide community benefits by way of charitable events or contribution outside the four walls of the department.
Passion: We demonstrate a passion for caring for others and the pursuit of service excellence in all that we do.
Integrity: We commit to the highest standards of behavior and doing the correct thing for the right reasons.
Partnership: Working together in collaboration and teamwork is more powerful than working alone.
Accountability: We take a responsible and disciplined approach to achieving our priorities and responding to an ever changing environment.
Innovation: We are capable of extraordinary creativity and are willing to explore new ideas to achieve our healthcare mission.
Respect: We respect the dignity, worth and rights of others.Physical Demands
•Sedentary: Exerting up to 10 lbs. occasionally, sitting most of the time, and only brief periods of standing and walking.
•Requires the ability to travel to member organizations as needed Note: the duties listed above reflect the majority of the essential duties of this job and does not, nor is it intended to, reflect all essential duties that may be required for an incumbent in this job to perform.
Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.