Job description
Job Description:
Under the general supervision of the Sr Director-Patient Financial Services (PFS), directs, plans, organizes and controls the integration of all WellSpan Health billing activities and functions related to the billing and follow up of assigned payer groups. Provides PFS operational oversight as needed; and monitors daily work activities including work queues and dashboards and directs the Government Leadership Team in all aspects of work queue management and employee engagement. Provides direct supervision of the assigned billing manager(s) and has oversight of and responsibility for 25 to 40 FTE’s including direct supervision of the Manager-PFS Government Billing.
Duties and Responsibilities
- Responsible for the oversight of all billing and follow up of all Government related payers including but not limited to contracted and non-contracted Commercial Payors, Highmark, Blue Cross, Blue Cross Out of State as well as other miscellaneous payers classified as Government payers. This includes the analysis of all work queue volumes and staff productivity reports in accordance with dashboard management and productivity standards.
- Ensures all regulatory guidelines are being met in all phases of the Government Billing revenue cycle.
- Monitors productivity and work standards and ensures productivity is within acceptable ranges.
- Provides direction and oversight to the PFS Government Manager in daily work queue activity and assists with review and analysis of billing reports on a daily/weekly/monthly basis to ensure timely filing.
- Directs the audit activity for payments, allowances and rejected claims to identify and resolve problems.
- Promotes/organizes staff development via in-service workshops and external educational opportunities.
- Assists the Sr Director in the development, implementation and analysis of protocol standards/work methodology consistent with industry trends and departmental objectives.
- Researches policies/procedures for Government payers. Directs the changes to established workflows consistent with the payer policies/procedures in order to assure accurate billing and correct reimbursement.
- Represents PFS and the Sr Director on various committees as assigned.
- Acts on behalf of the Sr Director as needed and serves as a liaison between PFS and other departments to ensure a consistent flow of information.
- Assists with system conversion and integration activities for current and future acquisitions.
- Provides PFS operational supervision (in absence of Sr Director) as needed.
- Actively resolves issues identified via the WSH Service Area Director Detailed Dashboard in accordance with the PFS Dashboard Management Policy. Provides education and direction to revenue leaders as needed.
Qualifications
- Notes:
- Other combinations of formal education, training and experience may be considered.
- Minimum Experience:
- 5—10 years experience of Hospital Billing
- Previous Leadership experience a must
- Previous Medicare/Medicaid experience preferred
- Min Field of Expertise: Patient Financial Services; Accounting; business administration
- Minimum Education:
- Bachelor's Degree
- Preferred Certification:
- AAHAM Certified Revenue Cycle Executive or HFMA Equivalent
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