Manager, Patient Accounts

Full Time opportunity exists in our Patient Financial Services for Manager of Patient Accounts/Follow-Up.

Manages the accounts receivable for the organization’s government, contracted non-cap managed care, commercial and workers’ compensation payors and accounts. Assesses, plans and implements actions to increase insurance cash collections while effectively utilizing staff and system resources. Manages health plan provider representative relationships related to claim issues. Insures compliance with all contractual, state and federal requirements. Manages EDI functions related to claim submission and electronic remittance. Insures compliance with HIPAA requirements.

Primary Duties and Responsibilities

1. Manages the Patient Accounts Government, Non-Cap Managed Care, Commercial, EDI and Workers’ Compensation Units insuring compliance with federal, state, and health plan standards and/or regulations. Adheres to contractual requirements. Maintains established DuPage Medical Group Coding and Reimbursement guidelines.

2. Analyzes related AR activity and develops or refines internal processes to consistently reach and maintain established AR goals. Evaluates and reports on the effectives of existing processes and all recommended/implemented improvements.

3. Monitors health plan claim payment/denial trends and identifies potential problems through established insurance follow-up activities. Works with health plan provider representatives and other DMG departments to resolve issues. Develops plan of action and implements process refinements to address and manage health plan problems and/or changes.

4. Responsible for setting goals and developing staff in the Supervisor position. Works with unit supervisors on development of Team Lead and Patient Account Specialist positions. Works with staff to meet goals and provides feedback.

5. Monitors insurance follow-up activities from initial health plan denials through to claim resolution. Takes an active role in developing supporting software and processes. Puts audit measures in place to insure compliance to departmental standards for all related activities.

6. Responsible for EDI claims and statement processes. Works to maximize effectiveness of EDI claim submission process, with emphasis on initial claim denial resolutions. Identifies areas where incoming processes improvements, staff training, and/or software upgrades may be made in order decrease payment lags.

7. Manages EDI vendor relationships to insure compliance with health plan and HIPAA electronic data transaction set standards. Recommends and implements changes in workflows in order to accommodate HIPAA requirements.

8. Monitors education for all newly hired Patient Account Representatives and EDI team members to insure all Patient Accounts policies and procedures are understood and consistently applied.

9. Reports staff production and audit results monthly. Provides analysis where appropriate. Completes quarter staff audit reports to insure compliance and consistency. Provides regular feedback to staff members concerning their audit results. Reports audit results to manager.

10. Proactively reviews established processes to ensure maximum collection opportunities. Develops, initiates and reports process improvements. Develops tools to monitor improvement results and measure performance.

11. Identifies root causes for identified problems and makes necessary changes to improve outcomes.

For more information about our career opportunities and to apply, please visit our website at www.dupagemedicalgroup.com

EOE
REQUIREMENTS
Special Skills or Licensure Requirements:

Strong knowledge of ICD-9, CPT, and HCPCS.


Education and/or Training Required:

Bachelor’s degree from a four-year college or university or two to four years related training.

Experience Requirements:

Two to four years of related experience.

Prior supervisory experience preferred.