Coordinates all functions of the Systems & Support department within the Business Office. Assesses the work performance of assigned employees and interacts in a professional manner with patients, companies, payers, physicians and other Medical Center personnel. Must provide accurate statistical records and reports. Proactive in the area of problem solving and works to ensure quality performance of business functions throughout the organization.
1. Hires, trains and supervises employees engaged in the day-to-day operations of the Insurance department of the Business Office.
2. Provides orientation for new department employees (including branch campus employees) to billing procedures.
3. Provides orientation and training on billing related information.
4. Oversees the implementation of new department procedures as required to ensure maximum department efficiency.
5. Holds regular department meetings to keep employees abreast of new organizational policies and department procedures.
6. Develops departmental and individual staff goals and strategies to attain such goals.
7. Ensures CH is compliant with billing and coding requirements dictated by government regulations.
8. Keeps abreast of legislation and regulations affecting reimbursement. Develops methods to effectively communicate and introduce required changes to billing processes and staff.
9. Ensures job descriptions are current for all department staff and creates new, or revises existing ones, as needed.
10. Ensures staff is current with safety and other medical center required updates, understands code and evacuation procedures, and adheres to business dress code guidelines. Appropriately addresses non-compliance in a timely manner.
11. Completes timely annual performance evaluations for department staff members.
12. Provides disciplinary action, as needed, for department employees. Works with the Human Resources department and Director through all termination procedures.
13. Works directly with department managers and clinical department staff on coding and billing related issues.
14. Attends and participates in regular Manager's meetings.
15. Attends seminars, workshops and conferences as needed or requested by Director.
16. Active participant in strategic planning surrounding ICD10 conversion to include training oversight.
17. Actively participates with Epic and Cerner module conversions/upgrades as they affect coding and billing requirements.
18. Participates and/or chairs CH committees or task forces as needed or requested.
19. Coordinates functions performed by Business Office staff with those performed by employees in other departments.
20. Develops policies and procedures pertinent to department and auditing processes. Makes appropriate changes as needed.
21. Develops departmental and individual staff goals and strategies to attain such goals.
22. Maintains monthly reports of the organization's A/R and of the performance of each area of the department.
23. Monitors reimbursement from third party payers to ensure they are complying with contractual obligations. Addresses specific concerns (i.e., payment challenges, denials, etc.) with payers as needed. Maintains productive working relationship with each payer.
24. Understands and complies with code and evacuation procedures.
25. Monitors department and individual workflow and assists where needed to ensure maximum efficiency. Adjusts workflow as warranted.
26. Ensures coordination of workflow for insurance billing and collections, payment processing and other support services through the Supervisor, Insurance Services and Lead positions.
27. Oversees the implementation of new department procedures as required to ensure maximum department efficiency.
28. Oversees time management of Business Office staff to ensure overtime is kept to a minimum. Monitors overtime needs and approves requests as required.
29. Ensures teamwork efforts are constant departmentally and interdepartmentally. Addresses non-compliance as needed.
30. Approves all refund requests over $2,500. Generates demand refund checks as required.
31. Participates with committees or work groups outside of the Organization that benefit the medical center as a whole.
32. Other duties as assigned.
Demonstrate Standards of Behavior and adhere to the Code of Conduct in all aspects of job performance at all times.
- Proficient in the performance of basic math functions.
- Knowledge of ICD-10 coding, medical terminology, and insurance billing a must.
- Bachelors' degree in Healthcare Administration, Business, or related field with two years relevant leadership experience.
- Current Confluence Health employees may substitute a Bachelor's degree with an Associate's degree with 6 years of relevant experience, 2 of which must be leadership; with a Bachelor's degree obtained within 2 years of hire; OR completion of the Confluence Health LEAD program.
- Must maintain primary residence in the Confluence Health service area.
- Previous supervisory experience preferred.
- Masters' degree.