Talent Search PRO
Location
Orange, CA | United States
Job description
Position Summary:
Responsible for planning, directing, and managing all aspects of Accounts Receivables management for the Patient Financial Services department; including commercial, managed care, workers compensation, ERISA, self-funded and all other indemnity health plans. Ensures standards of unit operations are in compliance with all state and federal healthcare regulatory agencies. Participates on organizational performance improvement projects. Analyze denial trends and publish organizational reports to improve first pass yield. Incumbent has overall responsibility for training, unit performance, resolution of operational and personnel issues, evaluations, hiring, and disciplinary action. Serves as a role model and resource to colleagues, staff, and others. Interacts with all levels within the organization, including senior leaders, managers, directors as well as insurance companies, third party payers, vendors, and regulatory agencies.
Required Qualifications:
Ability to motivate staff to achieve desired results
Sound understanding of Joint Commission and other applicable regulatory requirements to be able to monitor for compliance
Ability to maintain a work pace appropriate to the workload
Excellent written and verbal communication skills in English
Demonstrated experience building competency and developing skills of others
Must have experience in working with contracts, applying terms and conditions to claims and performing split billing as required by Contracted Payers and DOFRs.
Working knowledge of billing commercial claims, workers compensation, managed care and all other third party payers.
Detailed understanding of billing technical elements such as standard forms and data elements, coordination of benefit and third party liability billing and collection, electronic billing, data edit programs, reimbursement methodologies such as Diagnosis Related Groups (DRGs), Case Rate, Percent of Charges, capitation.
Thorough knowledge of healthcare billing, finance and compliance and strong understanding of facility billing systems.
Extensive knowledge of governmental compliance rules and issues as it pertains to health care billing, collection and other reimbursement.
Self- directed and organized with superior analytical and problem-solving skills.
Five (5) years' experience in a revenue based, health care related industry such as admissions, registration, billing/collections or contracting
Five (5) years' experience in management of Patient Financial Services
Experience in PFS Operations in an Academic Medical Center organization or complex teaching environment
Working knowledge of billing, follow up and denial management of commercial claims, workers compensation, managed care and all other third party payers.
Must possess the skill, knowledge and ability essential to the successful performance of assigned duties
Bachelor's Degree in related field
Preferred Qualifications:
Master’s degree in Health Care Management, Business, Finance or Accounting
Experience in PFS Operations, University and medical center organizations, policies, procedures and forms
Prior management experience of union-represented staff
Knowledge of University and medical center organizations, policies, procedures and forms
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