Job Abstract

Premier Orthopedics and Sports Medicine is looking for a Revenue Cycle Manager?to oversee our CBO located in Newtown Square, PA.

The Company: Premier Orthopaedics is a full-service orthopaedic practice formed in 2000 that specializes in the diagnosis and care for a wide range of orthopaedic injuries and conditions. Through partnership with the Healthcare Outcomes Performance Company (HOPCo), we have grown to over 50 specialty locations and over 100 physicians across the Greater Philadelphia region!

We’re proud of the company we’ve built as we’ve grown to over 1000 employees to make Premier a place that people love to come to work every day

At Premier Orthopaedics, we are dedicated to taking care of you so you can take care of business! Our robust benefits package includes the following:

• Competitive Health, Pharmacy, Vision, and Dental Plan Benefits
• Disability and Protective Benefits
• HSA with qualifying HDHP plans with company match
• 401k plan with company match
• Employee Assistance Program that is available 24/7 to provide support
• Benefits eligibility on the 1st of the month after hire date!

ESSENTIAL FUNCTIONS

• Manages the day-to-day operations of the billing department to maximize net revenues and cash flows by managing all aspects of the revenue cycle while ensuring adherence to policies and procedures.
• Monitors accounts receivable activities and initiates appropriate corrective measures as needed.
• Communicates performance data and associated action plans to Senior Leadership.
• Identifies and implements processes to achieve key revenue cycle metrics including but not limited to A/R days, unbilled A/R, denial percentage, and cash collections.
• Analyzes large volumes of data and provides financial analysis and regularly presents trends, movements, and status to Senior Leadership.
• Reviews billing work queues regularly to ensure that workloads are distributed evenly, and that the department metrics are being met.
• Resolves complex patient, physician, and other issues when necessary.
• Manages self-pay receivables including vendor relationships to help resolve A/R. Inclusive of self-pay receivables is the process of charity review and bad debt management.
• Develops and implements policies and procedures for designated areas; evaluates new systems and methods and recommends changes, as necessary.
• Communicates with payers and know when and how to escalate payer issues.
• Oversees the hiring, training, and supervision of department personnel and conducts performance evaluations on an annual basis.
• Maintains comprehensive knowledge of third-party billing requirements and reimbursement principles. Also maintains comprehensive working knowledge of payor contracts and ensures that payors are billed according to contract provisions.
• Conducts regular meetings with staff to discuss third-party reimbursement methodologies. Provides direction to staff on changes in managed care reimbursement and expectation of changes in insurance guidelines.
• Keeps abreast of compliance regulations, standards, and directives regarding governmental/regulatory agencies and/or third-party payers. Ensures communication and education of such to the Billing department as well as other Revenue Cycle Leaders.
• Must be able to meet deadlines given by Senior Leadership.
• Researches and resolves discrepancies in a timely manner.

EDUCATION

• Degree in Medical Billing and Coding or Certification in Coding or equivalent experience required.
• Bachelor’s degree or equivalent working knowledge preferred.
• BA/BS in Business Administration, Accounting, Finance, or equivalent is preferred.

EXPERIENCE

• A minimum of five (5) years of experience in a leadership role within a billing department in healthcare revenue cycle operations.
• Prefer experience working with Orthopaedic specialties.
• Prefer experience with billing for Physical Therapy or ancillary services.
• Previous managerial experience and strong leadership skills with an ability to motivate with a positive attitude that positively impacts others.

REQUIREMENTS

• Must be able to communicate effectively with physicians, staff members, patients, and the public and be capable of establishing good working relationships with both internal and external stakeholders.
• Must have a full understanding of the Revenue Cycle Management process to include Collections, Billing, and Coding.
• Experience analyzing and trending financial data.
• Excellent interpersonal skills including conflict management.
• Experience working in Microsoft products – Word, Outlook, and Excel (advanced formulas, pivot table).
• Well organized and able to meet deadlines.
• Ability to effectively manage and develop large medical billing teams and the ability to plan and organize workflow, activities, and schedules to ensure efficient departmental operations.
• Knowledge of claims processing and editing systems.
• Knowledge of the State of Pennsylvania Medicare, Medicaid, commercial payer and workers compensation Laws and Regulations.
• Knowledge of Knowledge of ICD-9, ICD-10, HCPS, and CPT coding, medical terminology, Medicare reimbursement guidelines and billing practices.
• Knowledge of government regulatory requirements.
• Ability to maintain patient confidentiality.
• Ability to multi-task in a fast-paced environment and work well under pressure.
• Ability to understand patient demographic information and determine insurance eligibility.
• Ability to identify opportunities for process improvement, identify solutions and plan for and implement solutions
• Excellent attention to detail.