Why You’ll Love This Job
The Patient Financial Services Director – PRISM oversees and manages PRISM Health’s revenue cycle and credentialing activities. Essential tasks include working with the VP of Revenue cycle to optimize the billing infrastructure for current services and expanded services. Responsible for directing Patient Financial Services to include, Billing, Collections, Customer services, Cash posting, Denial Management and Budget preparation. Coordinate the daily activities related to the planning, implementing and maintaining all functions pertinent to the Patient Financial Service areas. Upholds the Agency’s business ethics and revenue cycle management rules and regulations.
Job Duties and Responsibilities
Specific Responsibilities of the Job:
- Establishes internal controls to ensure timely and accurate billing to third party carriers and works with contracted third-party billing company to optimize billing and collection efforts.
- Works with the VP of Revenue Cycle to manage the revenue cycle related activities for all billable services provided and billed to Medicare, Medicaid, commercial insurances, as well as sliding fee scales and grant awardees, ensuring compliance with rules and regulations.
- Plans, develops, and implements a billing compliance process to identify potential risk areas and mitigates identified risks in order to ensure appropriate and correct documentation and coding of health care claims submitted for payments.
- Plans, develops, and implements a sliding fee, Health Insurance Assistance, income determination process that identifies potential risk areas and mitigates those risks to ensure appropriate and correct documentation and record keeping to ensure compliance with programs.
- Serves as the in-house credentialing, billing, and coding expert. Develops and provides targeted coding trainings to providers based on assessed coding challenges.
- Manages and is responsible for resolving all billing and coding related issues, including follow up with providers, access to the EMR, Availity, and other web-portals to ensure timely submission of claims, retrieval, and posting of EOB’s and other remittance details.
- Works with third party billers to resolve third party billing.
- Monitors fee schedule and routinely compares to contracted allowable rates to ensure fees charged are in line with market rates within the same zip code, including periodic review of fees charged compared to allowable rates for each insurance plan.
- Responsible for the set-up of insurance plans in the EMR, including follow up with insurance carriers and sign up for electronic remittance when applicable.
- Assists the VP of Revenue Cycle to plan, develop, and implement billing procedures, including the performance of periodic review and updating of billing and coding procedures.
- Reviews, creates, and issues claim processing related reports, including timeliness of claim submission and re-submission of rejected claims, tracking reasons for rejection, evaluates and documents trends.
- Reviews, creates, and issues claim denial related reports, including investigating and identifying most common denial reasons, and works with third party billers to develop process’ to mitigate denials.
- Responsible for developing process and procedures to improve point of service collections, as well as training and managing clerks in order to implement best practices.
- Responsible for developing and implementing process that promotes timely insurance verification and the completion of any prior authorization or ABN notification.
- Responsible for developing process and procedures to track, monitor, and optimize patient participation in available health insurance assistance, and patient financial assistance programs.
- Responsible for working uninsured, Ryan White, and Sliding Fee claims
- Stays current with revenue cycle management laws and regulations and changes in procedure (HCPCS) and diagnosis (ICD-10 codes).
- Responsible for working Ryan White Client bill statements/ patient billings
- Other duties as assigned.
- Prism Clinic Receptionists
- HIA Specialists
- Insurance Verification Specialists
- Financial Counselor/ Prior Authorization
Required Knowledge, Skills and Abilities:
- Demonstrated ability and experience to manage third party related contract.
- Demonstrated experience in working with practice management software.
- Demonstrated ability to manage multiple responsibilities in a complex environment.
- Demonstrated success and knowledge of physician reimbursement, medical terminology, ICD-10, CPT and HCPCS coding.
- Proficiency in MS Office.
- Must be able to coordinate effectively between multiple departments.
- Excellent written and oral communication skills.
Education and Experience:
- Bachelor’s degree preferred.
- 10 years of experience in a comprehensive and specialty care environment.
- Certification in coding and billing required.
Type: Full Time (Salaried)
Job ID: 115113