Overview

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.This regional position will be responsible for the management of all complex technical billing, analysis, and revenue/billing reporting, in excess of $30 million dollars annually, for all of the YNHH Departments of Radiation Oncology operations. Responsible for the coordination and supervision of daily billing operations to ensure maximum productivity, accuracy of claims submission and follow up through automated work queues while assisting with resolution of disputed claims. Insures department's compliance with all federal regulations and payer policies. Responsible for adherence to policy and procedures with respect to auditing, billing, coding, and documentation of compliant medical necessity. In depth knowledge of clinical operations and front end patient registration is required. This position will provide short- and long-term analytical support to the Director of Radiation Oncology for professional program planning. This position will directly supervise daily clinic operations in regards to the coding & therapy billing unit and will review, audit and recommend revisions to department billing policy and procedures as needed. This position will determine methods, priorities, timetables and monitoring for optimal gross and net revenue generation results in a weekly, monthly and annual basis and will exercise initiative, originality, and judgment in applying established billing principals under general direction by the Director of Radiation Oncology.EEO/AA/Disability/Veteran

Responsibilities

• 1. Billing Management, Compliance, Analytical Support, and Supervision
• 1.1 Ensures accurate and timely billing of all hospital technical charges. Provides supervision, training, and cross-training to the department coders. Assists in the development methods and formal planning systems for program activity. Monitors results of department hospital revenues and provides monthly and quarterly statistical analysis and operational feedback to benchmark operations and support financial statements. Reviews operational processes to ensure compatibility of the department practices to ensure federal compliance and financial profitability outcomes are attained. Development of work flows and system enhancements for process improvements. Process billing of daily code capture and billing operations for Professional and Hospital services. Includes coordination of the daily operations and work flow processes. Provide direct supervision of department coder/billers. Ensures electronic billing batches flow correctly over the interface from department EMR to EPIC, auditing 100% upload success. Directs and manages all administrative functions that contribute to the capture, management and collection of patient service revenue.
• 2. Compliance
• 2.1 Maintain a thorough and current knowledge of Federal and State Legislative and administrative actions affecting technical and professional reimbursement; disseminate acquired knowledge with the Hospital Billing office and contracts department as well as, the professional billing group.
• 3. Analytical Support
• 3.1 Works with internal hospital auditors providing education and documentation in support of radiation therapy services. Works with external auditors and consultants for reviews of current departmental practices making recommendations as necessary.
• 4. Data Quality Assurance and Revenue Generation
• 4.1 Reviews billing processes and procedures, recommend changes, revisions, or restructuring where needed to department leadership. Make recommendations regarding the design, modifications, and implementations of new charge templates within our department EMR system. Provides charge capture guidelines and instruction to clinical billing units within our department (physics, dosimetry, therapists, clinic and nursing). Makes appropriate recommendations to enhance efficiency. Develops and maintains all billing policies and charge capture/reference tools for each respective area on the department shared drive.
• 5. EMR Data Management & Billing Operations
• 5.1 Development, implementation, and ongoing maintenance of processes for automating and streamlining billing operations, including Charge Export Process. Assigned to EPIC Charge Subgroup for Resolute.
• 6. Continuous Quality Improvement
• 6.1 Initiate, research, and resolve billing discrepancies from patients, insurance carriers, Professional Billing Group, Patient Financial Services, Office of Billing and Compliance, or faculty members.
• 7. Business Support and Planning
• 7.1 Identify department goals and objectives related to billing and collection. Assist the Director of Radiation Oncology with setting and facilitating the attainment of goals. Assist with business planning and development of stats, coding, revenue and other assigned analysis. Review monthly denial and collections summaries, ID trends and bring to supervisor awareness. Continuous review for federal and regulatory changes and interpret or include in Radiation Oncology business. Analyze future reimbursement trends and perform retro comparisons to past fiscal years.
• 8. Serve as Liaison with Assigned Departments, Physicians, and Organizations
• 8.1 Function as liaison for the Radiation Oncology Department with the Professional Billing Group, Patient Financial Services, Contracts, Office of Billing and Compliance, insurance agencies, and patients; providing support to departments by analyzing, interpreting and supplying information and data. Work closely with System Business Office to identify and resolve problems and information to assist in adjudication of outstanding claims. Provide feedback and follow up to client departments on identified problems and trends. Keep department leadership informed of issues, regularly and frequently.

Qualifications

EDUCATION

Bachelor's Degree in Health Information Management or related field preferred..In lieu of degree, considerable work experience in radiation oncology billing/coding is and Certification as a CCS/CPC and/or ROCC required. Advanced knowledge of professional and hospital billing and reimbursement requirements for all payors. Comprehensive knowledge of medical diagnostic (including E & M procedures) and radiation oncology procedural terminology.

EXPERIENCE

Staff supervisory experience in a professional billing environment or other health care environment preferred Minimum of 3 to 5 years medical billing and insurance experience Radiation Oncology coding review and charge entry experience required Radiation Oncology specific EMR (MOSAIQ/ARIA) experience preferred

SPECIAL SKILLS

High level of proficiency using a computer required especially Microsoft Excel and Word. Organizational skills to analyze workload and strict attention to details, reporting variances as soon as discovered. Ability to communicate effectively. Ability to manage time schedules, deadlines, multiple requests and priorities as well as maintain productivity. Excellent writing skills to prepare complex documents. Ability to independently conduct research, perform quantitative analyses and develop recommendations for process improvements. Must be able to exhibit tact and diplomacy when dealing with faculty, staff, University personnel, and patients. Must have the ability to relate to management and fellow employees in a congenial and professional manner to resolve and clarify problems and/or questions related to job assignments and the work environment. Must be knowledgeable of State and Federal Billing Guidelines, CPT, RBRVS, HCPCS, and ICD-9/10-CM codes and their application. Must be able to remain current with and interpret and apply Medicare, Medicaid, and third party payor insurance guidelines. Must have advanced networking capabilities to work with outside cancer facilities and organizations (i.e. Cancer Care Network, SROA, AMAC, etc.) to facilitate and compare management practices and processes. Ability to exercise Judgment under general direction, and make independent decisions within the role of the position. Ability to research, collect, analyze and interpret data from a variety of sources. Ability to assume responsibility for compilation of clinical data related to inpatient and outpatient, Hospital and professional services, including diagnosis, procedures, and regulations.