SUMMARY:
Responsible for managing the Patient Accounts Department and for working with colleagues involved with the Revenue Cycle to maximize cash flow, optimize billing, follow up and collections, minimize denials and manage relationships with third party billing vendors for a medical group (“OHMG”), an ambulatory surgery center (“ASC”) and a hemophilia treatment center including the billing of blood factors (“Factors”) under the 340b program.
As an affiliate of UCLA through a master alliance agreement, Luskin OIC utilizes Epic (“CareConnect”) for its electronic medical record system, and Athena for its billing system.
DUTIES AND RESPONSIBILITIES:
Responsible for day-to-day operations of patient accounts office.
Acts as authorized point of contact with Athena HealthCare Company (“Athena”) the billing software company.
Organizes and prioritizes activities to meet organization’s goals and objectives.
Audits ASC and Factor charges to ensure accuracy and appropriateness.
Ensures that any errors identified by coder are corrected and pre-scrubbed in a timely manner to ensure clean claims.
Monitors and manages the CareConnect Work Queues daily to assure that the revenue from CareConnect transfers correctly and timely to the Athena platform for billing.
Maintains all Charge Masters.
EOB Remittance Review: Identifies procedures that were not paid or denied, reviews with Coding staff and appeals with appropriate documentation as needed.
On-Boards all new Providers and Staff members into Athena.
Prepares reports for providers and leadership team as requested.
Reviews and approves large dollar write offs and bad debt accounts after appropriate follow up.
Manages accounts receivable in coordination with reporting assistance from Finance Department.
Works with the third party payors to obtain letters of authorization or contracts for services to be performed.
Oversees all Factors billing activity, including charges, payment posting, adjustments and refunds to assure accuracy and stability of practice.
Manages financial activities of the department, including budgeting and review of revenue and expenses.
Oversees Medical Coding & Compliance for all ASC and OHMG Surgical Procedures.
Develops and implements policies and procedures that guide and support the department.
Responsible for recruitment, orientation, supervision and timely performance of department staff.
Promotes an environment that encourages team work and open communication.
Ensures compliance with federal, state and county regulations and certification requirements.
PERFORMANCE STANDARDS AND SUCCESS INDICATORS
Meet and maintain clean claim average of 95% as evidenced by Athena reports.
Maintain A/R, Aging and Days Revenue in AR at or below goal.
Provide timely and accurate data upon request.
Work closely with Patient Access staff to obtain authorizations and / or to quote case rates for services, as appropriate.
QUALIFICATIONS:
Bachelor degree in business or related field, Masters degree preferred.
Successful experience in healthcare billing setting with 5 years of progressive work history, with related management and supervisory experience.
Understanding of healthcare billing operations and knowledge of Medi-Cal and other government programs required.
Knowledge of MicroSoft Word and Excel along with other basic office equipment required.
Knowledge of the Epic and / or Athena systems are strongly preferred.
Must have good oral and written communication skills as well as excellent managerial skills.
COMPLEXITY:
Ability to perform highly detailed work with sustained attention while providing/obtaining information on numerous inquiries is paramount to success in this position.
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