What are the responsibilities and job description for the Enterprise Manager Quality Claims and Analytics position at Advocate Aurora Health?
Major Responsibilities:
Licensure, Registration, and/or Certification Required:
Education Required:
Experience Required:
Knowledge, Skills & Abilities Required:
Physical Requirements and Working Conditions:
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
- Manages and coordinates accounts receivable functions to ensure efficiency and maximum reimbursement. Analyzes processes to identify payer issues, results and progress, and implements plans for improvements.
- Assists in ensuring compliance with contracting agreements and governmental regulations.
- Provides systems guidance along with operation level understanding and direction. Assists both users and systems development staff with design, evaluation of controls, development of procedures, user training, and conversion.
- Acts as a liaison with insurance companies, government agencies, hospital departments, physicians, patients and/or their responsible parties.
- Assists in development and implementation of new services and programs.
- Develops and administers policies and procedures to accomplish department-specific and organizational initiatives.
- Utilizes key performance indicators to analyze processes in order to streamline workflow design operations, improve quality, service and revenue cycle performance.
- Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.
- Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives.
- Responsible for understanding and adhering to the organization's Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization's business.
Licensure, Registration, and/or Certification Required:
- None Required.
Education Required:
- Bachelor's Degree in Health Care Administration or related field.
Experience Required:
- Typically requires 5 years of experience in Revenue Cycle Billing Operations, accounting, or finance. Includes 1 year of supervisory experience in managing staff and budgets.
Knowledge, Skills & Abilities Required:
- Demonstrated leadership skills including project management, process improvement, problem-solving, decision making, prioritization, delegation, team building, customer service, relationship building, diplomacy, and conflict resolution.
- Strong interpersonal, communication and organizational skills.
- Ability to interact and positively influence at all levels of the organization to impact change
- Demonstrated knowledge of managed care contracts and/or government billing/payment regulations
- Demonstrated proficiency in the Microsoft Office Suite or similar products and in patient and billing systems. Epic experience highly desired.
- Demonstrated skills in financial and statistical analysis necessary to examine patient accounting activities and detect/resolve any related issues.
- Demonstrated ability to effectively manage claims processing, accounts receivable, billing audits, medial audits, and coding functions.
- Ability to deal and work effectively across departments and in matrix organizational structures. Strong negotiating skills. Strong oral and written communications skills as well as proven presentation skills.
Physical Requirements and Working Conditions:
- Operates all equipment necessary to perform the job.
- Exposed to normal office environment.
- Occasionally lifts up to 20 lbs. when lifting laptop personal computer.
- Exposed to road/weather conditions as required to drive to other sites.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
