BWPO BILLING MANAGER

Affiliate Name: Brigham & Women's Physicians Organization
Job Category: Professional/Managerial
Department: BWPO ORTHOPEDICS
Shift: Days
Hours/Week: 40
Job Type: Regular
Employment Type: Full TimeResponsibilities:
Working extremely independently, direct the professional fee billing operation of the BWPO Department of Orthopaedic Surgery and Department of Rheumtology, Allergy, & Immunology. The Department billing operation generates approximately $45 million in gross charges, $15 million in net collections, and 90,000 visits, 7,000 surgeries. Develop yearly revenue budget for gross revenues and net anticipated collectables.
PRINCIPAL DUTIES AND RESPONSIBILITIES: Indicate key areas of responsibility, major job duties, special projects and key objectives for this position. These items should be evaluated throughout the year and included in the written annual evaluation.
1. Direct the professional fee billing operation for the BWPO Department of Orthopaedic Surgery and Department of Rheumtology, Allergy, & Immunology. This includes managing all of the stages of billing from charge entry (either via electronic interface or manual charge entry), claims generation (electronic claims submission or paper), payment posting (electronic or via paper (EOB's)), and accounts receivable management. Working within the general system parameters of the BWPO, maximize efficiency of external billing operations by developing specific policies and procedures, managing the process, and measure the effectiveness of process.
2. Working either directly with employees or through supervisory staff of the external billing company, manage the workflow of approximately 100,000 claims per year. This includes supervision, evaluating performance, and termination of the billing company.
3. Oversee the information system (IS) for the billing operation, either working directly with the departmental IS liaison or indirectly through contact with the central BWPO IS staff. This includes troubleshooting all IS issues related to dictionary maintenance, charge entry, claim submission, payment posting, report generation, etc., independently identifying problem, proposing solutions, and monitoring problem resolution.
4. Monitor and actively work to resolve outstanding patient accounts receivable. Work either directly with third party payers to secure payment on delinquent accounts or through the BWPO administrative staff to resolve payment issues common to multiple departments. Research and identify issues specific to certain payers regarding claim rejection (such as rejection of certain CPT codes, specific requirements on claim preparation, or rejection of certain diagnosis codes), and advise Director of issues.
5. Analyze monthly billing and collection reports to monitor operation performance, advising Director of any trends or problems developing, assisting in the developing of action plans to address issues and plan any corrective action.
6. Assist Director in planning for the billing of new services, researching suggested fees, reimbursement rates, and any other billing requirements. Educate staff on new billing requirements.
7. Oversee the billing compliance program for billing operations, work with Director to make sure that all systems are regularly reviewed, billing staff is properly trained, and that any potential compliance issue is identified and addressed in a timely way.
8. Work with BWPO Chief Operating Officer, and other senior managers of the BWPO to coordinate information requests, problem identification, and problem resolution, to help the BWPO optimize its effectiveness as an organization. Ensure that departmental billing operation complies with all established BWPO policies and procedures.
9. Develop the departmental revenue budgets and forecasts: approximately $45M in gross revenue spread between 40 cost centers.
10. Perform all other duties as assigned.
REQUIREMENTS
QUALIFICATIONS: (MUST be realistic, neither overstated nor understated, and related to the essential functions of the job.)
Bachelors Degree required. 3-5 years of experience as a supervisor or manager of a professional fee billing operation of a clinical specialty (coding experience preferred), for either a billing agency, physicians organization, or other clinical department billing operation. IDX computer system software experience highly desirable, but experience working with a computer software system handling a large billing operation essential.
SKILLS/ ABILITIES/ COMPETENCIES REQUIRED: (MUST be realistic, neither overstated nor understated, and related to the essential functions of the job.)
1. Must be extremely well organized to handle multiple tasks simultaneously under sometimes tight deadlines.
2. Excellent communication skills to be able to communicate with a wide audience (e.g. billing staff, physicians, senior administrators, patients, third party representatives) on sometimes complex problems.
3. Ability to analyze a diverse set of information and to prepare and execute an action plan of problem identification and resolution.
4. Strong information systems familiarity essential. Ability to understand basic billing information system concepts in order to communicate effectively with IS staff to address issues.
5. Excellent problem solving skills
6. Ability to work extremely independently.
7. Ability to handle sensitive and confidential patient information.WORKING CONDITIONS: Describe the conditions in which the work is performed.
Sometimes fast-paced office environment with time-sensitive deadlines.
SUPERVISORY RESPONSIBILITY: List the number of FTEs supervised.
Responsible for the management and reporting of two separate and distinct external billing companies.FISCAL RESPONSIBILITY: Indicate financial 'scope' information, i.e.: size of budget, volume, revenues, etc.
Responsible for a billing operation of approximately $45 million in gross charges, $15 million in net collections, and 90,000 visits, 7,000 surgeries.
APPROVAL:(