GENERAL SUMMARY/ OVERVIEW STATEMENT:
Brigham and Women's Hospital is dedicated to:
- serving the needs of our local and global community
- providing the highest quality health care to patients and their families
- expanding the boundaries of medicine through research
- educating the next generation of health care professional
Every employee plays an important role in providing a positive impact on the organization and the people we serve. Your work will be distinguished by demonstrating respect and dignity in all interactions with patients, families and colleagues, excellence in customer service and job performance.
All employees are expected to embrace this commitment and demonstrate behavioral competencies in the following areas: People:
Focus on serving the community through collaboration and respect Self Management
: Accountability, professionalism and commitment to growth and development Organization:
A commitment to quality, service and exceptional performance
Meeting these expectations is key to the success of your department and the organization.
This job description includes:
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- General expectations for the position
- Addendum A - BWH Behavioral Competencies
- Addendum C - Physical/Working Conditions
The Clinical Operations Revenue Manager (CORM) position is responsible for managing the clinical revenue operations, including providing customer service in regards to patient billing inquiries, for the Departments of Neurosurgery and Psychiatry.
The CORM oversees clinical revenue cycle, including two direct reports. This includes responsibility for managing the Departments' E&M, procedural, and surgical billing process and interacts extensively with internal staff, located on the main campus as well as remotely at satellite locations. The CORM is the departments liaison to the Mass General Brigham's Combined Professional Billing Office where the CORM monitors and evaluates revenue cycle performance. This position provides front-line interface with the CPBO and supervises all aspects of A/R billing and collections for the Department. Additionally, the position develops and implements policies and procedures related to billing processes, A/R management and managed care. Develops related training documentation and provides staff training. Develops monthly reports to track revenue cycle performance and provides key analytical analysis to understand trends, support decision-making, and assists in long term planning.In cooperation with the CPBO and the Finance Manager, acts as the department's liaison with the CPBO on all revenue cycle matters. This includes managing or supervising (if outsourced) all of the stages of billing within EPIC 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, maximizes efficiency of external billing operations by developing specific policies and procedures, managing the process, and measuring the effectiveness of process.Supervises 2 FTEs as a direct reports, Billing Managed Care Coordinators - one for each department. Trains, reviews, and works alongside to complete all required and timely billing tasks such as referral and prior authorization acquisition.Tracks and obtains all referrals and prior authorizations for departments satellite offices. These sites, unlike BWH and BWFH, require the departments to obtain all prior authorizations for surgical procedures. Procedures, such as TMS, will also require prior authorization regardless of site.Identifies areas of underperformance from a documentation perspective and leverages extensive billing background to enhance charges and receipts.Post Operative Note reconciliation: Identify and correct all dates of service mismatches per auto generated EPIC time stamp system to ensure billing accuracy.Act as a liaison between BWH, Faulkner, and satellite hospital admitting (a non PHS site).Daily communication with third party payors for prior auth/eligibility or to resolve complex denials. Weekly communication with patients to discuss cost of procedures as well as existing balance and in some cases sets up budget plans (repayment plans).Responsible for working alongside Director of Neurosciences Clinical Trials Office to ensure billing accuracy and compliance for new devices and services used by research and clinical faculty.Performs audits of diagnosis billing compliance to ensure documentation supports level of care.Attends all PO related billing meetings including the Billing Communications Meeting and the Billing Managers Meeting.Brings billing process, payor, or other revenue cycle issues to the attention of the Director of Clinical Operations, Finance Manager, Executive Director and Clinical Faculty as needed.Assisting with obtaining the outstanding balances of international claims from the BWH International office.Provides informed recommendations to the CPBO for collections transfers and bad debt write-offs. Works with the practices and attendings to notify, inform, and educate staff to prevent future write-offs.Managing DAR and seeking continuous improvement through communication and effective processes and procedures in collaboration with the CPBO.Institutes effective tools to reduce lag on both office encounters and surgical billings.Working either directly with employees or through supervisory staff of CPBO, manages the workflow of approximately 90,000+ claims per year. This includes evaluating performance of the CPBO on behalf of the departments.Oversees the pre-revenue cycle (referrals, prior authorizations, charge capture, charge education, note documentation) to ensure revenue integrity for the departments working directly with Clinical Operations leadership, individual practices, and the CPBO. This includes troubleshooting all IS issues related to dictionary maintenance, charge entry, claim submission, payment posting, report generation, etc., independently identifying problems, proposing solutions, and monitoring problem resolution.Responsible for development, administration and training for surgical and ambulatory electronic charge capture mechanisms to reduce charge lag and ensure full service reconciliation.Manages both the surgical and procedural case carts at BWH, Faulkner and the other satellite hospitals. Pulls the radiology and surgical schedules, provides notes to the coder(s), and updates the case cart daily.Coordinates the referral spreadsheet on the shared drive. Interacts with the patient coordinators and the CPBO to ensure timely updates.Manages, completes, and trains Managed Care Coordinator(s) on all Charge Review/Claim edit EPIC work queues. This is for all surgical, outpatient Clinic, and inpatient billing transactions. Interacts with patient coordinators, PO staff and CPBO as necessary to complete edits.Monitors and actively works to resolve outstanding patient accounts receivable. Works either directly with third party payer to secure payment on delinquent accounts or through the BWPO administrative staff to resolve payment issues common to multiple departments. Researches and identifies 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 advises management team of issues. Responsible for management of all claims with a $5,000 balance and greater and instructs with CPBO AR team on how to collect payment.Works with Clinical Operations leadership to oversee completion of Provider Enrollment of all clinicians in third party insurance plans as it relates to the credentialing process.Generates and analyzes monthly billing and collection reports to monitor operation performance, advising Executive Director & Finance Manager of any trends or problems developing, assisting in the developing of action plans to address issues and plans any corrective action.Plans for the billing of new services, researching suggested fees, reimbursement rates, and any other billing requirements. Educates staff on new billing requirements. Submits tickets and/or requests to create new billing areas in EPIC.Work with the BWH/BWPO Compliance team to help oversee the billing compliance program for billing operations, works with Administrative Director and Operations Manager 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. Evaluates areas of potential risk, meeting with attending and fellowship physicians as needed to review areas of deficiency.Through payer denial trends, highlights and researches areas of non-payment, referring to payer Medical Policy to determine and dispute conflicting adjudication of claims. Attends Payer Medical Policy Meetings providing supporting clinical documentation to present the BWPO's opinions in an effort to resolve disagreements with third Party Payers' Medical Policy.Perform all other duties as assigned. Qualifications QUALIFICATIONSLevel of education required:
SKILLS/ ABILITIES/ COMPETENCIES REQUIRED:
- Bachelors degree required, Master's preferred.
- Two to three years experience in a busy academic medical center's performing revenue cycle work a plus.
- Three to five years of appropriate work experience.
- Knowledge of Medical Terminology is desirable but not required
- Excellent interpersonal skills and the ability to work well in a team environment.
- Excellent oral and written communication skills.
- Individual must be extremely organized, flexible, and independently motivated.
Technical Skills Required:
- Knowledge of practice operations and standards.
- Understanding of procedures including filing, copying, scanning, printing, and faxing.
- Highly proficient in all communication skills (phone, verbal and written).
- Ability to handle sensitive information and situations with poise and professionalism.
- Strong organizational, coordination and judgment skills.
- Ability to prioritize effectively.
- Ability to manage multiple tasks effectively, following established protocols, and work within systems.
- Advanced computer skills, especially Microsoft products (e.g. Word, Excel, PowerPoint, Access).
- Ability to use all applicable applications at highest competency level.
- Ability to problem solves and troubleshoots. Ability to analyze a situation and determine best course of action within established guidelines.
- Advanced understanding and use of medical terminology.
- Advanced comprehension of billing and fiscal information.
- Knowledgeable and compliant with all hospital, State and Federal requirements (where applicable to job performance), including policy and procedures with The Joint Commission and HIPAA.
Brigham and Women's Hospital is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, ancestry, age, veteran status, disability unrelated to job requirements, genetic information, military service, or other protected status.
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