Job description
Overview:
REQUIRED CERTIFICATES, LICENSES, AND REGISTRATIONS:
esponsible for development, oversight, and coordination of revenue cycle and accounts receivable operations including the functions of coding, billing, accounts receivable, and registration for the Jemez Health Center and the Emergency Management Services; conducts process mapping and systems monitoring to assure maximum collections and operational efficiency and effectiveness.
Responsibilities:
- Plans, organizes, assigns, supervises, reviews and evaluates the work of assigned staff.
- Recommends selection of staff; trains staff and provides for their professional development; administers discipline as required.
- Assists in planning goals, objectives, procedures and work standards for the program; collaborates in the development and adherence to annual budgets to facilitate optimal reimbursement and fiscal responsibility.
- Ensures proper scheduling of services and allocation of resources; evaluates program effectiveness and efficiency, ensures that such programs meet standards and regulatory requirements and professional standards; performs quality control of functions and staff.
- Provides professional advice and technical assistance to staff; investigates complaints and resolves problems regarding service delivery.
- Administers the billing and claims operations to include coding, accounts receivable credits and collections in compliance with regulations, guidelines, policies and procedures within the established quality and quantity standards.
- Provides documentation and implementation of operating procedures to ensure all claims are processed and paid; ensure submission of timely and accurate executed claims; and timely and accurate posting to patient accounts.
- Ensures timeliness and accuracy of claims follow-up, denials and appeals to determine the recoverability for POJ.
- Works with Medical Records, Medical Benefits, Purchase Referred Care and Credentialing staff to ensure third party collections are maximized through the screening process and alternate resources.
- Reviews and monitors Accounts Receivable; generates collections and revenue reports; monitors individual productivity; works with Finance staff to reconcile third party payer accounts.
- Establishes and maintains a comprehensive system of periodic audit and quality assurance by monitoring all Business Office functions.
- Assists Financial Analyst in financial forecasting.
- Acts as a liaison and negotiate with external providers’ representatives for the fair market price of medical services rendered for Jemez Health Center patients; ensure cost containment for the medical servic
- Monitors coordination of benefits to ensure maximum retur
- Works with external agencies, fiscal intermediary administration, claims processing staff, Purchase Referred Care and Credentialing staff, to identify and resolve problems with applications and operating systems.
- Acquires provider numbers through Credentialing staff, including the national provider identification number, for third party medical services; ensures providers are in compliance with licensing and certification requirements.
- Reports suspected fraudulent billable medical services to the Administrative Offic
- Ensures the billing and coding system is updated with current fee schedules, CPT, HCPCS and revenue codes.
- Develops reviews and revises policies and procedures for key aspects and operations of the Business Office; ensures staffs are trained and compliant in their use; and communicates the policies and procedures to others with a need to know.
- Stays current on federal, state, insurance benefit regulations, guidelines, processes, and procedur
- Develops methods or processes and makes recommendations to improve accuracy and timeliness.
- Establishes work priorities, schedules and project plans; tracks project status and reviews work in progress; gives periodic updates to internal staff and department staff.
- Provides operational improvements and recommendations to peers, management and external agencies.
- Contributes to the overall quality of the unit’s service provision by developing and coordinating work teams and by reviewing, recommending and implementing improved policies and procedures.
- Represents the Pueblo with dignity, integrity, and a spirit of cooperation in all relationships with staff and the public.
Education and Experience:
Bachelor’s Degree in Business Administration, Healthcare Administration, Public Administration, or closely-related field; AND five (5) years of business office experience in a healthcare delivery setting; two (2) years of which were in a supervisory/managerial role.
REQUIRED CERTIFICATES, LICENSES, AND REGISTRATIONS:
- Valid New Mexico Driver’s License.
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