What are the responsibilities and job description for the Operations Director position at Prestige Billing Services, Ltd.?
Position: Operations Director (OD)
Reports to: Executive Leadership Team & Board of Directors
Exempt/Non: Exempt, Full-Time
Education: Bachelor’s degree in business administration or related
Experience: 5 years of medical insurance/healthcare revenue cycle management and 3 years supervisory or management
Position Summary:
Under the supervision of the Executive Leadership Team, the Executive Operations Manager has the responsibility of overseeing and managing the Revenue Cycle staff and making day-to-day decisions.
The OD is responsible for understanding all insurance verification, coding, billing and finance procedures within regulatory mandates. The OD will manage workflow and efficiencies with claims coding and submissions, including insurance audits, denials and appeals.
This position is responsible for directing and coordinating the overall functions of each department to ensure maximization of cash flow while improving patient, physician, and other customer relations.
The Executive Operations Manager requires the ability to produce and present detailed billing activity reports to the Management Team and Board of Directors.
Responsibilities:
Operations:
Oversee the operations of the billing department, encompassing medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management
Serve as the practice expert and go to person for all insurance verification, coding, finance and billing processes
Plan and direct patient insurance documentation, workload coding, billing and collections, and data processing to ensure accurate billing and efficient account collection
Analyze billing and claims for accuracy and completeness; initiate reviews with payers for delayed or denied claims
Verify daily claims submissions for acceptance and reconciliation against patient daily census
Maintain contact with other departments to obtain and analyze additional patient information to document and process billings
Prepare and analyze accounts receivable reports, weekly and monthly financial reports in concert with the Operations and RCM Manager
Collect and compile accurate comparative financial reports to identify trending and impact on cash flow and client profitability
Audit current procedures to monitor and improve efficiency of billing and collections operations
Maintain a system of controls by enforcing checks and balances to minimize the risk of financial loss
Ensure that the activities of the billing operations are conducted in a manner that is consistent with overall department protocol, and are in compliance with Federal, State, and payer regulations, guidelines, and requirements
Review and interpret operational data to assess need for procedural revisions and enhancements; participate in the design and implementation of specific systems to enhance revenue and operating efficiency
Analyze trends impacting charges, coding, collection, and accounts receivable and take appropriate action to realign staff and revise policies and procedures with cooperation and support from the Operations Manager and Revenue Cycle Manager
Keep up to date with payer rule changes and distribute the information within the practice
Understand and remain updated with current coding and billing regulations and compliance requirements
Management:
Supervise RCM office personnel, which includes work allocation, training, and being available for staff needs; motivate employees to achieve peak productivity and performance
Coordinate the provision of training for new and existing RCM staff on applicable operating policies, protocols, systems and procedures, standards, and techniques
Develop or expand employee benchmarking and productivity incentives
Participate in the development and implementation of operating policies and procedures
Perform annual employee performance reviews
Client Service:
Identify personnel needs based upon expansion of client relationships as needed
Assist in the set-up and workflow for all clients
Augment existing report to highlight PBS and client strengths and opportunities
Identify and support development of new reports as requested
Design and implement programs to maintain a positive relationship between clients, PBS Board of Directors and staff
Professional:
Perform all duties and responsibilities in an efficient, team-oriented manner
Accountable for being knowledgeable and possessing an understanding of all aspects of the RCM staff duties
Conduct self in a manner that reflects a positive representation of the company, and encourages others to do the same
Observe strict patient and company confidentiality
Advance personal knowledge base by pursuing continuing education to promote professional competence
Promote individual and organization integrity by exhibiting ethical behavior to maintain high standards for PBS
Respond to the needs of others through effective communication, mutual respect and consistent follow through in order to generate trust and enhance personal effectiveness
Assist the Executive Leadership Team as needed to support and promote the goals of Prestige Billing Services, Ltd., and its clients
Reports to: Executive Leadership Team & Board of Directors
Exempt/Non: Exempt, Full-Time
Education: Bachelor’s degree in business administration or related
Experience: 5 years of medical insurance/healthcare revenue cycle management and 3 years supervisory or management
Position Summary:
Under the supervision of the Executive Leadership Team, the Executive Operations Manager has the responsibility of overseeing and managing the Revenue Cycle staff and making day-to-day decisions.
The OD is responsible for understanding all insurance verification, coding, billing and finance procedures within regulatory mandates. The OD will manage workflow and efficiencies with claims coding and submissions, including insurance audits, denials and appeals.
This position is responsible for directing and coordinating the overall functions of each department to ensure maximization of cash flow while improving patient, physician, and other customer relations.
The Executive Operations Manager requires the ability to produce and present detailed billing activity reports to the Management Team and Board of Directors.
Responsibilities:
Operations:
Oversee the operations of the billing department, encompassing medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management
Serve as the practice expert and go to person for all insurance verification, coding, finance and billing processes
Plan and direct patient insurance documentation, workload coding, billing and collections, and data processing to ensure accurate billing and efficient account collection
Analyze billing and claims for accuracy and completeness; initiate reviews with payers for delayed or denied claims
Verify daily claims submissions for acceptance and reconciliation against patient daily census
Maintain contact with other departments to obtain and analyze additional patient information to document and process billings
Prepare and analyze accounts receivable reports, weekly and monthly financial reports in concert with the Operations and RCM Manager
Collect and compile accurate comparative financial reports to identify trending and impact on cash flow and client profitability
Audit current procedures to monitor and improve efficiency of billing and collections operations
Maintain a system of controls by enforcing checks and balances to minimize the risk of financial loss
Ensure that the activities of the billing operations are conducted in a manner that is consistent with overall department protocol, and are in compliance with Federal, State, and payer regulations, guidelines, and requirements
Review and interpret operational data to assess need for procedural revisions and enhancements; participate in the design and implementation of specific systems to enhance revenue and operating efficiency
Analyze trends impacting charges, coding, collection, and accounts receivable and take appropriate action to realign staff and revise policies and procedures with cooperation and support from the Operations Manager and Revenue Cycle Manager
Keep up to date with payer rule changes and distribute the information within the practice
Understand and remain updated with current coding and billing regulations and compliance requirements
Management:
Supervise RCM office personnel, which includes work allocation, training, and being available for staff needs; motivate employees to achieve peak productivity and performance
Coordinate the provision of training for new and existing RCM staff on applicable operating policies, protocols, systems and procedures, standards, and techniques
Develop or expand employee benchmarking and productivity incentives
Participate in the development and implementation of operating policies and procedures
Perform annual employee performance reviews
Client Service:
Identify personnel needs based upon expansion of client relationships as needed
Assist in the set-up and workflow for all clients
Augment existing report to highlight PBS and client strengths and opportunities
Identify and support development of new reports as requested
Design and implement programs to maintain a positive relationship between clients, PBS Board of Directors and staff
Professional:
Perform all duties and responsibilities in an efficient, team-oriented manner
Accountable for being knowledgeable and possessing an understanding of all aspects of the RCM staff duties
Conduct self in a manner that reflects a positive representation of the company, and encourages others to do the same
Observe strict patient and company confidentiality
Advance personal knowledge base by pursuing continuing education to promote professional competence
Promote individual and organization integrity by exhibiting ethical behavior to maintain high standards for PBS
Respond to the needs of others through effective communication, mutual respect and consistent follow through in order to generate trust and enhance personal effectiveness
Assist the Executive Leadership Team as needed to support and promote the goals of Prestige Billing Services, Ltd., and its clients
