PFS Billing Manager - Full Time - Days

Jupiter Medical Center Jupiter , FL 33458

Posted 2 months ago

Jupiter Medical Center is reimagining how to restore the community's health and wellness. Award-winning physicians, world-class partnerships and innovative techniques and technology enable Jupiter Medical Center to provide a broad range of services with specialty concentrations in cardiology, oncology, imaging, orthopedics and spine, digestive health, emergency services, lung and thoracic, women's health, weight management and men's health. Our medical center consistently performs in the top 10 percent of hospitals for patient quality and satisfaction and has earned the highest rating in the region for quality of care.

Under the direct supervision of the Director of Patient Financial Services, the Billing Manager is responsible for managing all billing components for Hospital (Facility), Professional Group, Skilled Nursing Facility (SNF), Ambulatory Surgery, and Urgent Care billing. This position is responsible for leading and planning the billing operations for a 15-team member department. Responsible for establishing, designing, implementing, and enforcing billing policies and procedures, as well as streamlining and creating effective billing processes across multiple provider types, groups, and facilities. This position is highly visible and requires a strong leader with the ability to prioritize, plan, and direct the department.

  • Responsible for managing all billing components for Hospital (Facility), Professional Group, Skill Nursing Facility (SNF), Ambulatory Surgery, and Urgent Care; as well as familiar with FQHC Clinics' billing guidelines.

  • Understands CPT, HCPCS, ICD-10, and ICD-10 PCS coding guidelines and the use of all applicable modifiers.

  • Makes necessary recommendations for any changes to fees and/or billing processes.

  • Resolves issues and problems of billing system and discusses with software analysts.

  • Attends workshops, seminars and/or meetings on billing and accounts receivable issues as required.

  • Stays current on A/R information (charges, coding, billing) and distributes new information to appropriate personnel via meetings, memos, literature, emails, and other.

  • Performs appropriate billing personnel evaluations annually, or as required, and assigns responsibility to billing staff based on their skills.

  • Hires, supervises, coaches, and provides corrective and or disciplinary actions to billing staff according to policies and procedures.

  • Possesses a thorough working knowledge of billing requirement for various payors.

  • Oversees billing issues with clients, collection agency, third party payors, and others.

  • Conducts Evaluation and Management Coding Audits to ensure the organization is meeting integrity and standards according to regulatory agencies standards and regulations.

  • Conducts bi-monthly (or monthly) meetings with billing staff and appropriate personnel.

  • Conducts integrity audits to ensure compliance with billing policies and procedures are followed in combination with CMS and other governing bodies' guidelines.

  • Presents Month-end closing of the Hospital and Physicians billing statistics.

  • Plans and implements quality assurance for all billing processes.

  • Staffing discussions and planning/interviews; team building as well as personnel development, staff meetings, educating team responsibilities.

  • Assist with the implementation of changes and or updates of existing and new billing system; keeps relevant edits in place within the billing system.

  • Maintains applications' access and requests for staff as needed and or required.

  • Have proven ability to perform strategic planning and priority setting for a billing department.

  • Strong leadership skills with an ability to motivate direct reports.

  • Excellent communication skills both written and verbal, and interpersonal skills.

  • Performs other job-related duties as required.

  • Supports the PFS Director and other RCM Management by assisting with research of issues arising from billing and/or identified in reporting trends.

  • Supports the PFS Director and other RCM Management by presenting recommendations of QA activities geared to address specific areas of high risk in billing adequacy and compliance.

  • Assists the Director with reviewing, routing and monitoring appropriate resolution of Coding Compliance that pose risk to the Company; while developing process to prevent future discrepancies.

Additional Requirements:

  • Performs other job-related duties within the job scope as requested by CBO PFS Director.

  • Protects confidential and protected patient health information and maintains strict confidentiality in accordance with HIPAA Laws, regulations and company policy.

  • Presents a positive, professional appearance and conveys a professional demeanor in the performance of assigned duties.

  • Embodies the values of the organization's mission, vision, and goals at all times.

  • Represents Jupiter Medical Center in a positive and professional fashion and makes all individuals feel as comfortable as possible.

  • Conducts all business in a professional manner maintaining respect for all individuals.

  • Complies with departmental and company-wide policies and procedures.

  • Maintains constant awareness of potential safety hazards insuring necessary safety precautions.

  • Reads and complies with established Organization's and Patient Accounts policies and procedures.

  • Exemplifies the highest levels of quality and integrity aligned with the organization's standards, policies and procedures.

  • Applications utilized include: Excel, Word, Power Point, STAR, CERNER, E-Clinical Works, Point-Click-Care, 3M, HPF, Experian Claims Source, and others.

  • Undergraduate degree in Business, Finance, Accounting, and or Health Care Administration with 5+ years billing/coding experience; or a combination of education and 10+ years comparable work experience in a coding and or billing environment.

  • 2+ years of RCM experience preferred.

  • Knowledge of RCM billing and collections systems; especially strong knowledge in eClinicalWorks required.

  • Familiarity with payer reimbursement procedures and methodologies.

  • Ability to work independently while effectively managing different priorities and projects.

  • Ability to read, analyze, and interpret common and technical journals, statistical reports, and other related documents.

  • Ability to effectively present information to senior management, groups, and or board of directors as directed.

  • Ability to work with basic mathematical concepts such as probability, statistical methods, and fundamentals of plan and solid geometry and trigonometry.

  • Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

  • Ability to define problems, collect data, establish facts, and draw valid conclusions that drives process improvement, quality, and productivity.

  • Ability to analyze business situations, controls and risks, and recommend practical solutions.

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PFS Billing Manager - Full Time - Days

Jupiter Medical Center