Claims Manager - University Cancer And Blood Center

Our OneOncology partnering practice at University Cancer and Blood Center (UCBC) is on a mission to improve the lives of everyone living with cancer. This ambitious and important goal is what motivates the selfless, collaborative, courageous and exceptional people who make up our growing organization.

This is an exciting time to join UCBC. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of community oncologists and the patients they serve.

JOB SUMMARY:

The Claims Manager is responsible for the Billing, Cash Application and A/R Follow-Up functions within the Revenue Cycle function for a large multi-site healthcare provider with exceptional growth plans. This is remote position with travel to corporate office in Athens, GA as needed.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• In conjunction with the CFO and Vice President of Revenue Cycle Management, the individual will develop and manage key performance indicators for the department.
• Implements an effective denials management program that demonstrates success in reducing the company’s overall denial rate while improving operating efficiency and timeliness of collections.
• Analysis of accounts receivable data (e.g. days outstanding in AR, percent of accounts over 60/90/120 days old, bad debt percentages, DSO, etc.), extraction into meaningful presentations, and communication of results as well as identifying problem sources and developing an action plan for continuous improvement.
• Motivates the team to demonstrate continuous improvement in all areas.
• Ongoing interaction with Payer Contracting leadership to address problems that may arise and to ensure accurate and timely reimbursement.
• Develops and manages operating metrics such as backlog reporting, collections status, A/R > 90, credit balance ratio, employee productivity, managed care reporting, DSO, etc.
• Individual will have the ability to work with the Finance department in determining appropriate revenue recognition on a monthly basis for the company and achieving the required revenue and bad debt reserve targets.
• In conjunction with Finance and IT, the evaluation and implementation of technological tools to improve efficiency and productivity in the management of fee schedules, payer contracts, and accounts receivable.
• Analysis of data requirements to oversee the creation and production of a range of reports to address those needs, including denial reports, error reports, accounts receivable reports, revenue forecasts, and ad hoc reports.
• Development and reporting on benchmarks and key indicators of revenue cycle functions to be reported on a daily, weekly, and monthly basis.
• Works closely with Operations, IT, Human Resources and Finance teams to train staff as well as provide feedback and data on front-end processes such as data collection, point-of-service patient collections, authorizations, and insurance verification.
• Responsible for the management of 20+ employees responsible for the areas of, insurance collections, patient collections, credit balance resolution, payment posting, claims submission, denial management, Accounts Receivable follow up, and coding and documentation.
• Providing relevant and timely feedback to the operational leaders regarding coding and documentation.
• Works cohesively with the other departments such as operations, finance, accounting, managed care and legal to develop effective policies and procedures that drive operating performance while maintaining compliance with all federal, state and regulatory requirements.
• Performs other duties and responsibilities as required or assigned.

EDUCATION and/or EXPERIENCE:

• A thorough understanding of revenue cycle management is required, along with a thorough understanding of transactions involving federal, state or local government insurance programs (e.g., Medicare/Medicaid).
• The ideal candidate will have a minimum of three years of success in leading billing/revenue cycle operations, and client/vendor relationships, preferably in a healthcare professional services billing organization within a multi-site distributed environment experience.
• Bachelors degree in finance, accounting, healthcare or business administration preferred but not required.
• Oncology experience is preferred but not required.

OTHER SKILLS and ABILITIES:

• Ability to utilize the internet, specifically Medicare and Medicaid websites.
• Advanced knowledge of medical terminology as well as knowledge of government and private insurer rules and regulations. Advanced knowledge of CPT, ICD-10 and HCPCS coding, as well as in-depth knowledge of medical billing requirements.
• Must be proficient with computers with an understanding of medical billing software.
• Working knowledge of Microsoft Outlook, Word, Powerpoint and Excel.
• Must be able to maintain confidentiality in regards to HIPAA rules and regulations, as well as private company matters.