Oversees and monitors teams work adheres to legal, compliance, and reporting standards, overseeing implementation of feedback from team and per leader approval. Leads the completion of research and analysis of complex financial data, monitoring assigned area(s) on the proper use of expenditures. Oversees the management of inquiries from providers, members, attorneys, and other stakeholders; manages project execution and identify business needs with others to implement complex process improvement... more details
Description:
Job Summary:
Oversees and monitors teams work adheres to legal, compliance, and reporting standards, overseeing implementation of feedback from team and per leader approval. Leads the completion of research and analysis of complex financial data, monitoring assigned area(s) on the proper use of expenditures. Oversees the management of inquiries from providers, members, attorneys, and other stakeholders; manages project execution and identify business needs with others to implement complex process improvement efforts. Manages the analysis of data, performing follow-ups and implementing recommendations. Manages teams quality and providing recommendations and analysis to leadership. Facilitates and delivers specialized coaching to all audience(s). Partners with stakeholders to develop long-term plans for process improvement with cross-organization impact. Facilitates vendor relationships and ensures resolution quality issues.
Essential Responsibilities:
Provides developmental opportunities for others; builds collaborative, cross-functional relationships.
Solicits and acts on performance feedback; works closely with employees to set goals and provide open feedback and coaching to drive performance improvement.
Pursues professional growth; develops and provides training and development to talent for growth opportunities; supports execution of performance management guidelines and expectations.
Leads, adapts, implements, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends.
Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams.
Delegates tasks and decisions as appropriate; provides appropriate support, guidance, and scope; encourages development and consideration of options in decision making.
Manages designated work unit or team by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement; ensures all policies and procedures are followed.
Aligns team efforts; builds accountability for and measuring progress in achieving results; determines and ensures processes and methodologies are implemented; resolves escalated issues as appropriate; sets standards and measures progress.
Fosters the development of work plans to meet business priorities and deadlines; obtains and distributes resources.
Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams to execute in alignment with operational objectives.
Ensures the teams work is in compliance by: overseeing and monitoring the teams work to ensure they adhere to federal and state laws, and applicable compliance standards, and creating the monthly quality reports to leadership, and escalating unresolved issues to senior management.
Ensures accurate patient accounts by: overseeing the management of inquires from providers, members, attorneys, and other insurance personnel to answer a complex billing questions and evaluating new systems.
Manages the denial process by: leading the teams quality of performance affecting complex denials and ensuring effective remediation and overseeing the teams data analysis and partnership efforts when making recommendations while also performing follow-up and denial management activities related to the collections of outstanding self-pay and/or insurance balances while also recommending accounts and performs necessary outreach to guarantors, insurance companies and attorneys to ensure timely, accurate payments.
Ensures finances are completed accurately by: working within allocated budget for the assigned area by monitoring usage and ensuring proper use of expenditures.
Manages performance management initiatives by: monitoring the teams performance and providing coaching to ensure the teams work meets established performance levels and analyzes financial data and create complex solutions that require ingenuity, and are used by others to generate reports for relevant departments and medical centers to assess performance progress. uses advances knowledge to ensures quality to oversee performance to enable decision making by providing feedback and driving the implementation of strategies to ensure vendor performance of collections, coding services, systems, coverage validation, income verification also reviewing and validating invoices.
Manages process management initiatives by: using advanced knowledge of the technical and operational fields and critical information from other diverse areas to conduct root-cause analysis and plan process improvement projects and identify business needs with operations managers, IT, clinicians, and health plan managers while also implementing, complex planning to translate business needs into project requirements that are then used to develop project specifications and action plans.
Manages project management initiatives by: leads project execution and management efforts by managing team members to collaborate with stakeholders across functions to ensure the project is successfully executed and project-based changes are implemented.
Leads regulatory reporting by: researching and applying regulation standards to recommend policy updates, managing regulatory extracts while also reviewing the accuracy of the teams work and providing feedback and implementing required changes.
Facilitates with vendor relationships by: maintaining and managing relationship with vendors by working with senior internal and external contacts to manage execution of work in accordance with organizational guidelines and applying advanced knowledge to institute new regional procedures, guidelines, strategies, and methods for managing vendor relationships.
Manages systems management initiatives by: collecting feedback, providing training, communication, and facilitating the review, validation of the build, preview and comment on adoption of new systems updates for the team, and escalates complex issues to senior management.
Facilitates training delivery by: facilitating and delivering training, recommending training priorities, and recommend training delivery methods based on policies, audit findings, and work curriculum.
Manages the training development process by: using advanced knowledge of the field and critical information from other diverse areas to identify education and training requirements that reflect revenue cycle changes to review new strategic training content.
Minimum Qualifications:
Minimum two (2) years of experience in a leadership role with or without direct reports.
Bachelors degree in health care administration, business administration, or related field AND a minimum of one (1) year of experience in data analytics, merchant services, clinic/hospital operations, banking, health care billing and collections, or relevant experience OR Minimum four (4) years of experience in data analytics, merchant services, clinic/hospital operations, banking, health care billing and collections, or relevant experience.
Preferred Qualifications:
Preferred one (1) years of experience managing operational or project budgets.
Four (4) years of experience in business/process analysis.
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