Mgr Acct Resolution -Claims Follow Up
Wellstar Health Systems

Facility: WAB - Wellstar Administrative Building
Job Summary: Under the direction of the Director of Account Resolution, the Manager of Accounts Resolution plans, and coordinates all HB Accounts Resolution department activities for an account receivable portfolio of ~ approximately $375M-$500M, including, but not limited to supervising, training, interviewing, hiring, counseling and terminating employees, as circumstances dictate. The Manager of Accounts Resolution and Denials Management must provide the dynamic development of strategies for establishing a continuous improvement work environment, ensure eligible accounts are reviewed, appealed, escalated or adjusted within the designated payer time frames and are documented appropriately in the patient accounting system, daily operational control for all governmental and / or non-governmental insurance follow-up related functions and provide the enterprise with denial management and educational support in a variety of system wide, departmental and individual settings. The role requires extensive data analysis, trending analysis, project management, workflow design and departmental educational capabilities regarding payor and revenue cycle business related processes. This role requires a versatile and well developed understanding with demonstrated knowledge of billing, collections, denial management, contractual provision interpretation and provider / payor appeal requirements. In addition to a strong understanding and capability of common business technologies such as MS Office, Excel, PowerPoint, Word and Outlook to perform and communicate the assessment and analysis of multiple acute care and LTAC facility accounts receivable portfolios. The core role focus of this position is to ensure that accounts are brought final resolution through reimbursement for services and to mitigate financial losses through solid operational execution, development and conformity to defined Policies and Procedures. The Manager must possess the ability to develop and document action plans for quick resource deployment and communicate timely with staff to understand the specific reasons for payment delays. The role requires the ability to effectively and efficiently communicate both orally and in writing to Senior Leadership, multi-task, meet deadlines, enforce organizational policies and procedures, maintain high staff engagement, ensure staff productivity, appropriate cost controls and produce effective operational execution. In addition, the Manager will assist with additional Revenue Cycle related tasks and duties as assigned. Core Responsibilities and Essential Functions: 1. Maintain a working knowledge of all-departmental billing and follow-up processes and functions, responding appropriately to inquiries from patients regarding accounts, collection issues and hospital policies, to insure a minimal Accounts Receivables inventory. a. Demonstrate effective departmental leadership, and provide direction to the staff in the performance of their daily functions by assisting with daily planning, organizing, prioritizing and management of operations, review accounts receivables evaluating trends, optimizing workflow and process to reduce AR growth, quickly creating action plans to reduce trends, resolving issues, etc. b. Manage and supervise professional level staff, providing direction and guidance to the same, creating a team environment through training, recognition/evaluation, and in-service education which produces optimum work habits and job performance c. Set obtainable strategic and short-term goals, maintaining expected level of staff productivity as well as conducting performance studies to improve productivity, streamline operations and reduce error rates. Provide assistance with staff training and oversight that newly implemented policies and procedures are being followed. Meet deadlines established through interaction with the Director of Accounts Resolutions or other senior leadership. d. Review and improve work procedures to ensure that the most productive and efficient methods are used e. Monitor progress for each area on a daily basis, utilizing quantitative productivity reports and providing feedback to staff f. Provide assistance with departmental projects and presentations, as needed. g. Maintain and reflect a positive team attitude, regarding any special projects or polices that are implemented by the Revenue Cycle or other senior leadership. h. Resolve complaints and misunderstandings in a timely and appropriate manner while demonstrating the ability to tactfully handle difficult situations through an approach that reflects consistency and fairness. i. Must maintain a proficiency of, key automated systems that include: Epic, Emdeon Claims Master, etc. j. Act as an internal resource; resolving problems and providing assistance to other hospital departments k. Review write-off requests, miscellaneous cash adjustments, and submits to director for approval l. Maintain Epic assigned workqueues to ensure timely (7 days, or as specified resolution of review requests m. Ensure defined audits required of accounts receivables are completed accurately and submitted on time. 2. Management and direction of human resources, job requirements, performance improvements, professional organizations, etc.: a. Assist with hiring, special recognition, disciplinary actions, promotions and transfers for the department as well as developing annual employee performance reviews including merit recommendations. Must be timely in interaction with staff related to any Human Resource activity to ensure timelines are met and communication is occurring. b. Prepare departmental statistics regarding productivity, quality and performance measures. c. Responsible for presenting monthly management and quarterly staff meetings. d. Maintain a working knowledge of WellStar policies and procedures relating to employment, and of relevant state and federal regulations that address the employment and supervisory process. e. Maintain membership and active participation in the HFMA professional organization, or equivalent, to participate in workshops and classes ensuring a competency level beneficial to the department, as well as to meet minimum requirements in technology advances/applications. 3. Assist with coordinating and managing assigned vendor relationships, including attending monthly or quarterly meetings which may require overnight travel. a. Consistently communicate with vendors and their staffs to ensure ongoing issues are resolved in a timely manner. b. Obtain monthly invoices from vendors and reconcile activities to ensure proper payments for services rendered are occurring. c. . d. Assist with reports for each vendor to insure viable outcomes with patient accounts in accordance with vendors contracts, policies & procedures, etc. e. Review/ Audit accounts from vendors to ensure consistency with WellStar documented Policies and Procedures. 4. Must actively participate and support the efforts of the Revenue Cycle Task Force, Monthly Denials Task Force, Monthly Compliance Coding Partnership as well as other committees as assigned. a. Maintain ongoing communication with other PFS and Revenue Cycle departments, keeping the Director of Accounts Resolution aware of more complex problems and opportunities while maintaining courteous, cooperative, flexible and positive working relationships with all levels of management, employees, physicians, guests and the general public. b. Review denial reports; determine significant problems causing rejections and denials; communicate with hospital departments the findings and proposes denial prevention solutions c. Maintain a working knowledge of relevant legal and compliance issues, including but not limited to HIPAA privacy, Fair Debt & Collection Act guidelines, Medicare & Medicaid regulations, as well as state and federal laws. d. Maintain effective communications with legal collection groups, the WellStar Compliance department and other agencies, regarding new and relevant issues must maintain appropriate knowledge and skill sets to read and interpret various regulatory requirements that affect follow-up functions. Maintain appropriate documentation to assure an audit trail of compliance-related activities. e. Communicate with and obtain assistance from various type insurance, third party collection, governmental and regulatory agency representatives, in the interpretation of critical regulations and the collection/resolution of patient accounts. 5. Direct the development, processes and efficiency of Insurance Follow-Up policies & procedures to ensure they are comprehensive in nature, current and consistently updated. a. Consistent review of current processes to ensure compliance with policies and procedures. b. Establish controls and review mechanisms for every procedure to ensure that systems and procedures are being followed correctly c. Ensure optimal system capabilities by coordinating with vendors and IS, providing training, documentation system parameters, challenging systems and obtaining feedback from staff/users. d. Create, update, edit, revise and communicate necessary changes of said policies and procedures within the department as well as to other necessary areas within WellStar. e. Assist in the development, implementation and control of the Insurance Follow-Up departmental budget, including determining cost and justifying staff requirements as they relate to the successful completion of all Follow-Up policies and procedures. Performs other duties as assigned Complies with all WellStar Health System policies, standards of work, and code of conduct. Required Minimum Education: High school diploma or equivalent Required Bachelor's Degree in business, healthcare or related field Preferred Required Minimum License(s) and Certification(s): All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s):Required Minimum Experience: Minimum 4 years experience in managing hospital patient financial services or related area. Required Must have a thorough understanding of Medicare, Medicaid and Commercial: healthcare revenue cycle functions, PFS operations, Medicare and Medicaid regulations and reimbursement, collection control points, along with project management, denials management, performance improvement experience. Required Change management and Lean Methodology experience Preferred A proven track record of successful performance management and progressive growth within the Revenue Cycle Required Required Minimum Skills: Strong interpersonal, mathematical, analytical, computer, problem solving and writing skills, with a take charge attitude. Must be comfortable interacting with physicians and senior leadership. Must possess strong leadership skills. Must be able to perform a wide variety of tasks that require independent judgment, ingenuity, and initiative. Competent with MS Word, PowerPoint and MS Excel is required as critical analysis will be conducted using this technology. Ability to: establish a climate to achieve optimal performance levels and maintain a cohesive work team, work efficiently under pressure and deal effectively with constant change, operate a computer and related applications, apply appropriate supervisory, management and leadership techniques in an operational setting, work independently and take initiative, demonstrate a commitment to continuous learning, deal effectively with difficult people and/or difficult situation, willingly accept responsibility and/or delegate responsibility, set priorities and use good judgment for self and staff

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