Manages billing, reimbursement system, revenue cycle processes and manages compliance program. Develops policies and procedures to ensure the timely resolution of patient services and third-party reimbursement issues to foster an environment of total customer responsiveness. Develops and implements changes to patient service programs in accordance with changes in insurance regulations. Serves as a liaison to various departments and physicians regarding issues including technical coding issues. Develops audit reporting systems to ensure accurate and timely billing to meet system goals and results. Upholds the standards of the system-wide customer service program.
Develops procedures to reduce front-end issues to ensure increased cash collections and patient satisfaction.
Serves as liaison to Institutes regarding reimbursement collection and customer service related issues.
Develops training programs for medical staff and ancillary personnel regarding coding procedures as related to reimbursement and other patient service issues. Develops management reporting systems to ensure accurate and timely reporting of goals and results.
Develops, implements and monitors a quality control program for the timely and accurate resolution of patient and insurance inquiries.
Performs audits as required. In partnership with physician leadership, oversees the Clinical Affairs compliance reporting committee.
Monitors changes in regulatory coding issues, monitors compliance with documentation guidelines and testing physician regulations.
Other duties as assigned.
Bachelor's Degree required.
Complexity of Work:
Within the scope of the job, requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
Must be able to work in a stressful environment.
Minimum of 8 years of functionally relevant experience required.
Offset: High School Diploma / GED or equivalent and 13 years of progressively responsible experience.
Personal Protective Equipment:
The policy of Cleveland Clinic and its system hospitals (Cleveland Clinic) is to provide equal opportunity to all of our employees and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. Job offers will be rescinded for candidates for employment who test positive for nicotine. Candidates for employment who are impacted by Cleveland Clinic's Smoking Policy will be permitted to reapply for open positions after 90 days. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic facility.
Cleveland Clinic is pleased to be an equal employment employer: Women/Minorities/Veterans/Individuals with Disabilities