What are the responsibilities and job description for the Manager PFS position at Jupiter Medical Center Physicians Group, Inc.?

Job Description

Ranked #1 for Safety, Quality and Patient Satisfaction, Jupiter Medical Center is the leading destination for world-class health care in Palm Beach County and the greater Treasure Coast.

Outstanding physicians, state-of-the-art facilities, innovative techniques and a commitment to serving the community enables Jupiter Medical Center to meet a broad range of patient needs. Jupiter Medical Center is the only hospital in Palm Beach, Martin, St. Lucie and Indian River counties to receive a 4-star quality and safety rating from the Centers for Medicare & Medicaid Services (CMS).

Education

Undergraduate degree in Business, Finance, Accounting, and or Health Care Administration with 5 years billing / coding experience; or a combination of education and 10 years comparable work experience in a coding and or billing environment will be considered.

Experience / Qualifications

5 years of RCM experience preferred.

Knowledge of various RCM billing systems preferred.

Familiarity with payer reimbursement procedures and methodologies.

Ability to work independently while effectively and simultaneously managing different priorities and projects.

Applications utilized to include Excel, Word, Power Point, STAR, AllScripts, CERNER,

E-ClinicalWorks, Point-Click-Care, 3M, HPF, Experian Claims Source, and others.

Ability to read, analyze, and interpret common and technical journals, statistical reports, and other related documents.

Ability to effectively present information to senior management, groups, and or board of directors as directed.

Ability to work with basic mathematical concepts such as probability, statistical methods, and fundamentals of plan and solid geometry and trigonometry.

Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Ability to define problems, collect data, establish facts, and draw valid conclusions that drives process improvement, quality, and productivity.

Ability to analyze business situations, controls and risks, and recommend practical solutions.

Have proven ability to perform strategic planning and priority setting for a billing department.

Strong leadership skills with an ability to motivate direct reports.

Excellent communication skills both written and verbal, and interpersonal skills.

Position Summary

Under the direct supervision of the Director of Patient Financial Services, the Hospital Billing Manager is responsible for managing all billing components for the Hospital (Facility). This position is responsible for leading and planning the billing operations for a 15-team member department. Responsible for establishing, designing, implementing, and enforcing billing policies and procedures, as well as streamlining and creating effective billing processes across multiple provider types, groups, and facilities. This position is highly visible and requires a strong leader with the ability to prioritize, plan, and direct the department; which might also include assisting in managing some of the organization’s professional billing components and processes; such physicians’ group and urgent cares.

Understands CPT, HCPCS, ICD-10, and ICD-10 PCS coding guidelines and the use of all applicable modifiers.

Makes necessary recommendations for any changes to fees and / or billing processes.

Resolves issues and problems of billing system and discusses with software analysts.

Attends workshops, seminars and / or meetings on billing and accounts receivable issues as required.

Stays current on A / R information changes and updates (charges, coding, billing) and distributes new information to appropriate personnel via meetings, memos, literature, emails, and other; as obtained from changes with regulatory agencies such as CMS, and others.

Performs appropriate billing personnel evaluations annually, or as required, and assigns responsibility to billing staff based on their skills.

Hires, supervises, coaches, and provides corrective and or disciplinary actions to billing staff according to policies and procedures.

Possesses a thorough working knowledge of billing requirement for various payors.

Oversees billing issues with clients, collection agency, third party payors, and others.

Conducts Evaluation and Management Coding Audits to ensure the organization is meeting integrity and standards according to regulatory agencies standards and regulations.

Conducts bi-monthly (or monthly) meetings with billing staff and appropriate personnel.

Conducts integrity audits to ensure compliance with billing policies and procedures are followed in combination with CMS and other governing bodies’ guidelines.

Presents Month-end closing of the Hospital and Physicians billing statistics.

Plans and implements quality assurance for all billing processes.

Staffing discussions and planning / interviews ; team building as well as personnel development, staff meetings, educating team responsibilities.

Assist with the implementation of changes and or updates of existing and new billing system; keeps relevant edits in place within the billing system.

Maintains applications’ access and requests for staff as needed and or required.

Supports the PFS Director and other RCM Management by assisting with research of issues arising from billing and / or identified in reporting trends.

Supports the PFS Director and other RCM Management by presenting recommendations of QA activities geared to address specific areas of high risk in billing adequacy and compliance.

Assists the Director with reviewing, routing and monitoring appropriate resolution of Coding Compliance that pose risk to the Company, while developing process to prevent future discrepancies.

Performs other duties as assigned

Establishing Relationships

Builds effective networks, working relationships, and alliances with a broad range of stakeholders (both internal and external) in order to collaborate effectively within divisions and across boundaries. Can relate to all kinds of people regardless of background; find topics and common interests that can be used to build rapport with others.

Developing Talent

Provides guidance and feedback to help others strengthen knowledge / skills needed to accomplish tasks, solve problems, and perform effectively.

Inspiring and Motivating Others

Fosters commitment and cohesiveness by motivating, guiding, and facilitating cooperation within the department toward goal accomplishments. Can persuade others, build consensus, and ensure cooperation from others to gain genuine acceptance to accomplish “win-win” solutions.

Demonstrating Emotional Intelligence

Exercises self-leadership, self-awareness, and self-regulation; manages emotions so that they are expressed appropriately; leads others by showcasing adaptability, empathy, and social skills.

Acting with Integrity

Interacts with others in a way that is seen as direct and truthful; ensures confidence in individual and organizational motives and representations. Acts in a way that is consistent with personal and organizational values by keeping confidence, promises, and commitments. Clearly states goals and beliefs; informs people of their true intentions, does what they say they will do; follows through on commitments.

Acting Strategically

Aligns day to day activities around broader organizational goals and objectives; prioritizes resources based on the strategic objectives of the organization.

Being a Champion for Change and Innovation

Supports people in their efforts to try new things. Generates novel and valuable ideas and uses these ideas to suggest new or improved processes.

Communicating Effectively

Speaks and writes clearly, conveys information in a concise, organized, and logical manner. Listens attentively and exercises tact, discretion, and diplomacy when interacting with members of the department and across the organization.

Promoting Diversity and Inclusion

Treats all people with dignity and respect by being fair and consistent. Demonstrates an open-minded approach to understanding people regardless of their gender, age, race, national origin, religion, ethnicity, disability status, or other characteristics. Challenge’s bias and intolerance. Develops all-inclusive groups in the realms of social interaction and communication. Shows respect for the beliefs of others; encourages and promotes practices that support cultural diversity; discourages behaviors or practices that may be perceived as unfair, biased, or critical toward people with certain backgrounds.

Holding Self and Others Accountable

Sets clear performance expectations and objectives for self and others; evaluates work performance and provides feedback when needed. Accepts responsibility and accountability.

Physical Requirements

Requires sitting for long periods of time, also stooping, bending, standing, and stretching. Must have manual dexterity for typing and computer data entry. Able to work under a stressful environment, work independently, capable of making sound decisions, be detail oriented, alert, and self-motivated. Ability to push / pull up to 40lbs., carry and lift up to 20lbs. Travel as needed.

Threshold Requirements

These threshold requirements are required and completed yearly basis

Annual Joint Commission mandatory education requirements, in-service and health requirements including attendance at new employee orientation

TB / PPD Surveillance Program

Maintenance of required professional licensing and / or certification(s).

This is not necessarily an extensive list of all responsibilities, skills, duties, requirements, or working conditions associates with the job. While this is intended to be an accurate reflection of the current job, management reserves the right to revise the job or require that other or different tasks be performed when circumstances change. I have reviewed these job requirements and verify that I can perform all essential functions of this position.

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