Leads the direction and strategy of Horizon Eye Care's revenue cycle operations. Leads the Central Business Office and PreCert Departments, along with oversight of the billing compliance plan. Serves as Compliance Officer for the entire organization. Manages Business Services Manager and directs the functions of the Precertification and business office to ensure maximum revenue flow. This position is part of Horizon's senior management team with additional responsibilities for the success of the entire organization, completion of the annual business plan and close collaboration with the physicians and other managers.
- ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Monitors revenue flow via system graphs and reports daily to identify trends that may impact practice revenue.
- Works with other members of senior team to identify anything that could negatively impact revenue and identify solutions, and on strategic practice initiatives for increasing revenue.
- Prepares monthly dashboard reports and quarterly reports for executive leaders and physicians.
- Manage and submit Medicare/Medicaid and some commercial insurance data for quality incentive programs.
- Oversee credentialing and contracting for insurance networks, including review and negotiation of contracts.
- Ensures organization procedures are sound from an internal controls perspective.
- Manages the Patient Retention Specialist to ensure that scheduling templates are designed to maximize encounter volumes and efficient patient flow, as well as ensuring appropriate follow-up with patients who have not returned for recommended treatment.
- Ensures all background system settings are correct to facilitate scheduling and reduce opportunities for scheduling errors and approves requested scheduling template changes.
- Reviews reporting of retention efforts for effectiveness as well as for analysis of reasons patients do not return.
- As Practice Compliance Officer, ensures that the practice operates according to applicable laws, rules, and regulations.
- Leads the practice Compliance Committee, conducts meeting to discuss and resolve compliance questions or concerns, and updates policies as appropriate.
- Consults with risk management medical malpractice insurance carrier and advises practice on related matters.
- Performs monthly OID and SAM exclusion reviews.
- Provides internal support for NextGen Practice Management system and provides back-up support for the HER system.
- Works with external support vendor for updates, issues, and the addition of new functionality.
- Performs system build functionality.
- Reviews update release notes to determine impact to practice and educates departments that will be impacted.
- Test updates and new functionality prior to putting it into production.
- POSITION REQUIREMENTS:
Minimum Qualifications:
- Bachelor's degree in Business Management, Finance or related field.
- 8 + years of experience in medical billing. At least 3 years of experience at the management level.
- Demonstrated skills in analytics and preparing dashboard reports.
- Experience with healthcare compliance and risk management
Travel:
(__) No travel between offices is required.
(X) Travel between or to different offices may be required.
Supervision Received:
Works independently with minimal supervision.
Supervisory Responsibilities:
( X ) No Supervisory responsibilities
( X ) Yes, this position supervises the following positions/departments (and approximate number of staff): Business Services Manager (1); Credential Contracting Coordinator.
Key Relationships:
Communicates verbally and in writing internally to Horizon employees, doctors, and patients as well as external business partners where applicable. Internally, builds and maintains relationships with Horizon employees (inside and outside of department) and doctors. Maintains external relationships where required.
IV. KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
- Mental Skills: Clerical; memorization; repetition; organization; analyzing; perception/comprehension; math skills; judgment; decision-making; socialization; attention to detail and communication/poise. Supervisory positions requires the understanding of complex reading and writing, and ability to demonstrate strong analytical and project management skills.
- Interpersonal Skills: Demonstrates active listening techniques; gains support through effective relationships; treats others with dignity and respect; seeks feedback.
- Technology Skills: Effectively uses all technologies provided; demonstrates proficiency in various commercial software programs including Microsoft Word, Excel, PowerPoint and Outlook as required for the position, electronic health record systems, document management, time management, payroll, HRIS and benefit enrollment systems.
- Customer Service Skills: Actively listens to internal and external customers and responds in a helpful, professional and timely manner to provide a consistent patient experience.
- Communication Skills: Position requires ability to read, write, and communicate in English; ensures that all communications, whether written or verbal, are clear, complete and concise. Supervisors may be asked to present information in front of teams, management, doctors or company-wide.
- Leadership Skills for Supervisors: Demonstrates willingness to try new tasks, generates new ideas for change, evaluates and recognizes priorities; challenges others to learn; keeps current and integrates new information; communicates and models organization values; and fosters high performance.
V. WORKING CONDITIONS:
Works in a team environment; has verbal and face-to-face contact with others; works in indoor areas; works around office equipment, moving objects, and electrical equipment. Work may be performed in crowded pods or offices with other staff sharing space.
Minimal or no exposure to adverse conditions.
VI. REMARKS:
In addition to the specific tasks identified above, the expectation is that this is a full-time position, unless specifically identified as part-time, working within assigned work hours of the office and/or department (minor variances expected). The employee in this role is expected to perform quality work within deadlines, interact professionally and respectfully, work effectively as a team and independently as appropriate, always follow the code of conduct and all Horizon policies and procedures. The employee will also abide by Horizon training guidelines under the Compliance Program, and will remain compliant to its components including OSHA, HIPAA, Centers for Medicare and Medicaid Services, Managed Care Contracts, and North Carolina and federal laws.
While this is intended to be an accurate reflection of the current job, this is not necessarily an all-inclusive list of tasks and working conditions associated with the job. Management reserves the right to revise the job or to require that other or different tasks be performed when circumstances change (i.e., changes in personnel, workload, or technological developments) based on business need.