System Manager Revenue Cycle (Medicare Hospital Billing & Collections)

At Houston Methodist, the Manager Revenue Cycle position is responsible for the daily management of the staff and operations for one or more of the following areas of Revenue Cycle, to include but not limited to: medical coding, insurance billing, collections, patient account resolution, appeals/denials, customer service, cash applications, revenue integrity, etc. This position is also responsible for monitoring and improving all revenue cycle metrics and measures, including but not limited to the following: accounts receivable days, cash collections, denials, avoidable write-offs, staff productivity and work quality and credit balances.

The manager position responsibilities include managing the daily work activities of the work unit/department staff, ensuring quality, productivity, functional excellence and efficiency while assisting management in accomplishing strategic and operational objectives. In addition, this position provides guidance to staff and is responsible for staffing, budget compliance, contributing to staffing decisions such as hiring and terminating employment, coaching and counseling employees on work-related performance, and assisting in the development and implementation of policies and procedures to ensure a safe and effective work environment.

This position also implements training, monitoring and operations initiatives that secure compliance with ethical and legal business practices and accreditation/regulatory/government regulations.

FLSA STATUS

Exempt

QUALIFICATION

• Education: Bachelors degree in business, healthcare or a related field or additional four years of experience (in addition to the minimum experience requirements listed below) in lieu of degree
• Experience: Five years of revenue cycle or other applicable experience to the area assigned (e.g., call center, medical billing, insurance collections)
• Two years of supervisory or management experience. If overseeing revenue integrity related functions, two years of supervisory or management experience in revenue cycle management required

LICENSES AND CERTIFICATIONS

• Required: CPC - Certified Professional Coder (AAPC) or equivalent if overseeing revenue integrity related functions
• Preferred: Additional certifications or licenses as required by the department

SKILLS AND ABILITIES

Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations. Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security.

Ability to effectively communicate through a variety of channels with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles; engages the recipient(s) and helps them understand and retain the message.

Demonstrates the ability to interact with others in a way that gives them confidence in one's intentions and those of the organization. Ability to use appropriate interpersonal styles and techniques to gain acceptance of ideas or plans; modifying one's own behavior to accommodate tasks, situations and individuals involved.

Demonstrates leadership qualities and critical thinking through self-direction initiative and effective interpersonal skills and oral/written communication skills. Ability to identify and understand issues, problems and opportunities, comparing data from different sources to draw conclusions; using effective approaches for choosing a course of action or developing appropriate solutions; taking action that is consistent with available facts, constraints and probable consequences.

Ability to work effectively in a fast-paced environment. Demonstrates flexibility and adaptability in the workplace. Ability to serve as a subject matter expert in assigned area to provide support for staff. Knowledge of full revenue cycle. Proven track record of effective management skills and driving desired results. Skilled in coaching, mentoring, and developing staff. Ability to cultivate relationships and lead cross-functional teams within the Revenue Cycle.

Assertive while being even-tempered, pleasing personality and the ability to communicate easily with others. Advanced Excel skills, including V Lookup and pivot tables with the ability to manipulate large amounts of data. Familiarity with managed care terminology and payor adjudication such as Inpatient/Outpatient Prospective Payment Systems, etc. Stays informed of the latest Medicare, Medicaid and commercial payor news, updates, and regulations and adjusts processes and procedures based on the changes with support from the Director.

ESSENTIAL FUNCTIONS

PEOPLE ESSENTIAL FUNCTIONS

• Performs management responsibilities of selection, scheduling, supervision, retention, and evaluation of employees in the department.

• Provides development and mentoring of staff.

• Meets or exceeds threshold goal for department turnover.

• Develops direct reports to perform these same functions.

• Provides fair and consistent leadership and communication to maintain a competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees, completing performance appraisals, conducting new hire feedback sessions, coaching/corrective counseling, and providing recognition/commendations to achieve desired outcomes.

• Provides timely guidance and feedback to help others strengthen specific knowledge/skill areas needed to accomplish a task or solve a problem.

• Facilitates and promotes effective team dynamics and teambuilding strategies within and between departments; participates and/or leads and facilitates department process improvements as needed.

• Meets or exceeds threshold goal for department and/or system metrics on employee engagement indicators: action readiness score, tier level.

• Manages the development and timely monitoring of work distribution and work performance levels for designated staff, in order to ensure work quality and to reach or exceed performance standards related to departmental goals and objectives.

SERVICE ESSENTIAL FUNCTIONS

• Plans and organizes day-to-day department operations, schedule and activities.
• Sets priorities and functional standards, giving direction to staff as necessary to ensure the best possible delivery of service and high customer/patient satisfaction.
• Drives department service standards and activities to impact department and/or system score for patient/customer-based satisfaction, through role modeling and fostering accountability.
• Serves and actively participates on various entity committees as a voice for the department.
• Manages employee training, education and in-services, in addition to unit and/or department meetings, resources and equipment, to ensure staff competency and professional pathway progression.
• Communicates updates/changes to processes, managed care information, throughput, etc., in a timely manner.
• Ensures appropriate and timely representation and response for all correspondence, meetings and matters related to revenue cycle.
• Builds relationships with external customers to include physicians, staff, and third-party vendors.
• Ensures requests from internal and external sources are addressed accurately and timely.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Ensures a safe and effective working environment; monitors and/or revises the department safety plan and/or any specific accreditation/regulatory required safety guidelines, including infection control principles.
• Monitors and confirms staff maintain their required credentials that demonstrate competency per accrediting agency or department guidelines as applicable.
• Uses and optimizes information systems to enhance operations; supports entity-specific performance improvement and data management/analysis functions.
• Employs a proactive approach in the optimization of safe outcomes by monitoring and improving the department workflow, using peer-to-peer accountability, reporting accidents, near misses, and/or adverse events immediately per department protocol and identifying solutions via collaboration.
• Adopts lean principles in driving process improvements.
• Role models situational awareness, using teachable moments to improve safety.
• Monitors self and employee compliance with policies, procedures, and System HR Standards of Practice and performs associated actions upon non-compliance (i.e., focal point review requirements, disaster plan, in services, influenza immunization, wage and hour, standard hours, timely termination submission, timely timecard approval, etc.).
• Ensures the quality of the work performed by the staff including following defined work protocols, conformity with policies and procedures, and provides quality reviews.
• Reports results of key performance metrics to director on a timely basis.

FINANCE ESSENTIAL FUNCTIONS

• Assists in the development of department budget and ensures that the department operates in a cost-effective manner.
• Manages/audits department expenses within approved budget parameters, ensuring that the department meets the budgeted/flex revenue and/or expense targets on a monthly and annual basis.
• Develops staffing plans and schedules to meet department needs that reflect understanding of the importance of cost-effectiveness.
• Implements department strategies to achieve financial target and staffing needs, developing others to do the same, through optimizing productivity, supply/resource efficiency, minimizing incidental overtime and overtime percentage, and other areas according to department specifications.
• Partners with Internal Audit, Business Practices, Health Information Management, Patient Access Services, and Utilization Review as needed to ensure operational billing compliance with government/regulatory agencies and the Medicare and Medicaid programs.
• Ensures optimization of timely cash collections and minimizes loss internally and in collaboration with external partners such as third-party billing companies, clearinghouses and vendors.
• Analyzes operations to avoid unnecessary denials and write-offs (financial), decrease agings and identify problematic activity.
• Initiates revenue enhancement projects and special projects after ongoing revenue cycle analysis.
• Meets with payors and/or Managed Care to discuss aged accounts, adjudications timeframes, and erroneous denials.
• Ensures that insurance follow-up and billing efforts result in optimal reimbursement.
• Gathers and analyzes financial information regarding charges, payments and accounts receivable.
• Interprets and/or evaluates information and/or creates analytical approaches.
• Analyzes operations to identify problematic activity impacting accounts receivable aging, denials, and write-offs for departments and physicians.
• Collaborates with the Client Services Managers or appropriate contact to analyze department operational impact on revenue resulting in optimal and timely revenue.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Identifies and implements innovative solutions for practice or workflow changes to improve department operations or other department-specific measures by leading unit projects and/or other department/system directed activities.
• Supports change initiatives, maintaining effectiveness when experiencing major changes in work responsibilities or environment; adjusts effectively to work within new work structures, processes, requirements or cultures.
• Proactively evaluates processes; recommends and implements action plan(s) for change; follows through to ensure effective, sustainable change.
• Participates in the development and implementation of new procedures and the review and revision of existing procedures.
• Identifies opportunities and takes action to build strategic relationships between one's area and other areas, teams, departments, and units to