MSRDP Billing Operations Manager - Surgical Billing Follow Up
Categories: Insurance / Billing
Department: MSRDP Team 4 Admin
Full/Part Time/PRN: Full-Time
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information
Experience and Education
High School diploma or equivalent and eleven (11) years experience in physician practice plan, healthcare, or medical insurance environment to include three (3) years supervisory experience and previous exposure to hospital or physician billing. Bachelor's degree and certified Professional Coder (CPC), Advanced Records Technician (ART), or Registered Records Administrator (RRA) preferred.
1. Manages the centralized front end revenue cycle for an assigned group of departments.
2. Manages staff and regularly analyzes operational volume to determine appropriate staffing requirements. Oversees the development of workflows to maximize staff productivity; monitors, evaluates and prioritizes projects such that established deadlines are met. Maintains policies and procedures. Manages staff recruitment and selection process. Oversees administration of annual employee performance appraisals.
3. Manages employees responsible for resolution of outstanding Accounts Receivable. Assures timely and full collection of physician fees billed to Medicaid, Medicare, Managed Care, Commercial and other third-party payers. Analyzes, recommends, and implements policies and procedures as needed to maximize reimbursement for all services rendered in compliance with established third party guidelines. Compiles, analyzes and reports status, issues and recommendations for accounts receivables; manages overall production of claims according to departmental procedures.
4. Constantly evaluates current charge capture and claim denial follow-up processes to ensure all revenue cycle systems are utilized to maximize charge capture and reimbursement. Ensures all charges are processed and billed accurately and in a timely manner. Reports deficiencies and change recommendations to the Director.
5. Maintains effective communication with department senior staff to ensure receipt of new provider hire information, report charge capture and clinical documentation issues, resolve billing issues, and develop charge capture workflows for new programs and service lines.
6. Works with the front end revenue cycle billing compliance team to: (a) Research and analyze reimbursement rules, regulations, and policies; (b) Develop billing policies and procedures for new technology and service lines; or (c) Assist in making appropriate billing and reimbursement policy recommendations.
7. Monitors revenue cycle dashboard lag reports that include charge review, claim edit, and follow-up metrics. When required develops or improves processes to achieve and maintain the metric standards.
8. Designs and compiles periodic financial reports for management to include analysis of revenue and medical service activity. Acquires and maintains thorough knowledge of Federal and State Legislative and Administrative action affecting physician reimbursement; disseminates acquired knowledge to faculty.
9. Duties performed may include one or more of the following core functions: (a) Directly interacting with or caring for patients; (b) Directly interacting with or caring for human-subjects research participants; (c) Regularly maintaining, modifying, releasing or similarly affecting patient records (including patient financial records); or (d) Regularly maintaining, modifying, releasing or similarly affecting human-subjects research records.
Performs other duties as assigned.
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; gender, including sexual harassment; age; disability; citizenship; and veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.