Summary:

This role is responsible for the maintenance of Revenue Cycle system applications: (including Provider Maintenance, Service and Procedure tables, Charge Masters, Fee Schedules, and researching and building of future system applications including Credentialing & Contract Management, this role will act as liaison between Revenue Cycle department, Patient Access Team, and all PCHC management and providers to research and resolve requests related to their position.

This role is responsible to maintain the automated credentialing system to assure operational efficiency and meet strategic goals; maintain Contract Management system in collaboration with the Chief Financial Officer, Controller and Director of Revenue Cycle and others; and effectively resolve reimbursement issues.

Uder the direction of the Director of Revenue Cycle this role is responsible to develop and implement organizational policies and procedures in areas of responsibility and will ensure organizational compliance.

This role will apply in-depth functional knowledge, managerial and leadership expertise to achieve focused business goals. This role is responsible to identify long term solutions to utilizing systems to improve operations and will implement short term solutions to allow the organization to operate at peak performance.

Essential Duties & Responsibilities:

• Effectively manage credentialing staff.
• Manages and maintains Revenue Cycle applications. Coordinate the review and ticket creation to correct issues related to billing, coding, posting, and credentialing related problems.
• Research, build and implement new applications to improve organizational efficiency and reimbursement outcomes.
• Assists in the quality assurance and re-training of Patient Access/Front Desk Staff using documented issues found during Revenue Cycle review.
• Works with Front Desk Supervisors to develop training tools and workflows to improve registration accuracy.
• Maintains a high level of knowledge of PCHC Front Desk operations, workflows, and technology. Assist in the preparation of documentation needed to make system updates and improvements.
• Responsible for oversight of provider and credentialing databases, and associated modules, ensuring accuracy of data and reporting to downstream systems. Work with credentialing staff to ensure distribution, receipt, processing, and timely delivery to appropriate internal and external individuals/entities.
• Responsible to maintain procedure manual documenting credentialing processes. Monitor critical data for extensive analysis and report generation.
• In coordination with the Controller, Revenue Cycle Director, and Managers, review financial viability of new services and/or programs as directed.
• Identify reimbursement and/or contractual issues, associated data collection, and development of recommended actions for improvement for presentation to management.
• Leverage analytical knowledge and team leadership skills to drive the development of automated improvements in the electronic health record system.
• Establish developmental and individual improvement plans for staff consistent with organizational mission, vision, and values, as needed.
• Proactive in the collection of all pertinent information from internal and external sources to assure the tables/systems are processing information correctly and timely.
• Communicates consistently with internal and external stakeholders to obtain and verify information.
• Identify opportunities for efficiency and implement initiatives, including new procedures, to improve processes in areas of responsibility.
• Assist in the review and respond to issues related to Compliance and internal and external audits related to areas of responsibility.
• Remain current in regulatory and compliance aspects of billing, reimbursement, coding, and credentialing, including State & Federal laws, regulations, and contractual agreements.
• Other duties as assigned.

Essential Skills / Qualifications:

• Strong problem solving and business acumen skills with an ability to work independently, manage priorities, develop strong relationships with internal and external stakeholders.
• High degree of proficiency in Microsoft Excel and other Microsoft Office suite products.
• Strong data management skills.
• Highly motivated and results oriented with excellent prioritization, critical-thinking, multi-tasking and communication skills.
• Must demonstrate strong analytical skills and attention to detail.
• Ability to train, coach and mentor staff.
• Ensures staff evaluations include targeted goals and oversees completion in a timely manner.
• Excellent interpersonal skills

Direct Reports:

• Credentialing Specialist.
• Other staff, as applicable.

Education Required:

• Associate degree in Health Care Administration, Business Administration, or a related field, or an equivalent amount of education and experience.

Experience Required:

• 2+ years experience with provider credentialing or related experience.
• 1+ years of experience with health care reimbursement.
• 2+ years’ experience with Healthcare Patient Accounting systems.
• 2+ years supervisory/management experience preferred.
• 2+ years’ experience in managing financial tables preferred.

LANGUAGE SKILLS

Ability to understand HIPAA security regulations; read, analyze, and interpret general professional journals, technical procedures. Ability to read, analyze, and interpret technical directives is required. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Ability to effectively present information in one-on-one and small groups.

MATHEMATICAL SKILLS

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. Intermediate mathematical skills.

REASONING ABILITY

Ability to apply common sense understanding to carry out instructions furnished in written or verbal form. Ability to deal with problems involving several variables. Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical regulations.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle or feel.
• The employee frequently is required to reach with hands and arms.
• The employee is required to stand, walk and climb or balance.
• The employee must regularly lift and/or move up to 10 pounds.
• Specific vision abilities required by this job include color vision, close vision and ability to adjust focus.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

SUMMARY OF OCCUPATIONAL EXPOSURE:

Classified by CDC as Low Risk