MANAGER, PATIENT REVENUE

General Description of the Job Class:

Oversees and coordinates billing and insurance collections and underpayments by payer and compliance guidelines to maximize reimbursement, achieve A/R aging targets, minimize avoidable/controllable write-offs, and accomplish results as cost-effectively as possible.

Duties and Responsibilities of this Level: (with percentages provided)

A/R and Underpayment Management-60%

• Perform independent revenue cycle operational decisions to timely and accurately resolve complex AR issues that are impacting billing and collections.
• Manage hospital and professional accounts receivable across multiple vendors with a strong focus on billing, collections, and denial resolution.
• Manage hospital underpayment collections based on payer contractual and fee schedule obligations.
• Monitor collection performance of DRO, cash collections, and aging through daily/weekly/monthly review of dashboards, AR summary reporting, and other relevant KPIs.
• Develop and maintain a working knowledge of relevant compliance requirements, payer billing requirements, claim logic, and reimbursement regulations related to hospital and professional billing.
• Identify root causes related to delays in payment from insurance payers. Collaborate with vendors, payer relations, and contract coordination on trends found through account review.
• Research operational and system issues identified by staff, and develop/implement solutions for performance improvement
• Oversee documentation of high-risk and AR issues log, addressing payer trends, system issues, and staffing performance with a focus on identifying process improvement opportunities.
• Prepare a weekly report summarizing inventory statistics, staff productivity, collections performance, and accounts receivable aging trends
• Identify deficiencies in staff performance and backlogs in inventory statistics promptly, and take action to address outstanding issues
• Work with the denials analyst and other departmental analysts to monitor denial rate trends, and identify & implement opportunities to reduce post-billing denial rates
• Review and approve write-off requests per policy. Provide feedback to Vendors and internal staff if write-off requests are not in compliance with policy requirements
• Review avoidable write-off trends and implement opportunities to reduce avoidable write-offs.
• Work with other PRMO management and DUHS leadership to improve collections, reduce accounts receivable, reduce claim edits, improve clean claim rate, reduce denial rates, and reduce avoidable write-offs through issue identification, research, communication, and process improvement
• Define criteria and set up vendor and Underpayment workqueues to ensure timely and comprehensive collection of all accounts receivable
• Monitor work queues daily to ensure appropriate workflow priorities are maintained
• Assign staff to all insurance queues to ensure appropriate and equitable resource allocation and prioritization of the outstanding workload
• Prepare a monthly summary of accounts receivable by entity/division/payor for director review, with explanation for changes in performance and specific plans to address deficiencies
• Develop and maintain documentation summarizing workflow processes and operating policy and procedures related to Hospital and professional collections.
• Develop internal controls for all operational processes and ensure the timely completion of internal control processes by staff, supervisors, analysts, and/or managers.

• Oversee supervisor's efforts in posting, recruiting, and hiring new employees
• Oversee supervisor's efforts to provide job-specific training to new and existing employees
• Oversee supervisor's mid-year and year-end performance evaluations of employees
• Oversee Analyst efforts to analyze, trend and identify and resolve AR issues for the team
• Post, recruit, and hire direct reports
• Provide job-specific training for new and existing direct reports
• Conduct mid-year and year-end performance coaching evaluations and provide feedback to direct reports
• Review the results of monthly employee performance, and take action on underperforming staff results
• Assist with the development of job-specific training programs for all staff within the team
• Identify and implement programs to develop direct reports and associated staff for career development
• Conduct and participate in routine team meetings and huddles to review team performance, share new policy and procedures, and keep employees informed about PRMO updates
• Identify and implement opportunities for improvement of staff morale
• Advocate and promote Culture Pulse
• Ensure compliance with all PRMO and DUHS personnel policies

• Prepare and submit for approval an annual budget for the team
• Review actual vs. budgeted variances every month, and provide a summary of the explanation to the Director
• Identify negative budget variances, and provide an explanation and game plan for addressing deficiencies
• Identify opportunities to reduce or minimize personnel and non-personnel costs
• Respond to inquiries from PRMO and DUHS leadership, peers, and staff in a timely, accurate, and comprehensive manner (i.e., 24-48 hours, depending on circumstances)
• Adhere to all PRMO and DUHS revenue cycle policies and regulations
• Respect and maintain confidentiality regarding patient/guarantor financial data and patient medical data consistent with HIPAA standards
• Provide coverage for the Director in her/his absence
• Provide coverage for the Supervisor in her/his absence
• Responsibility for all supervisor responsibilities on smaller teams that do not have a supervisor
• Other duties as assigned