An Equal Opportunity Employer, including persons with disabilities and those with Veteran status.
The Manager is primarily responsible for assuring that clear lines of authority, communications and delineation of all hospital and physician billing and denial duties have been established and assigned with direction from the Senior Manager. The Manager will oversee all applicable hospital and physician billing and denial job functions as stated in organizational and departmental policies and procedures. The Manager is responsible for researching, analyzing, resolving and trending rejections and/or denials specific to the revenue cycle. This includes, but is not limited to, analyzing specific denial categories and codes, researching the underlying reason for the denial, rectifying the issue in the denials management system and ensuring that the claim is adjudicated.
The Manager will provide educational programs related to billing and denial resolution techniques with the approval of the Senior Manager to stimulate growth and a professional department. The Manager is responsible for keeping informed of new changes in federal, state and third party regulations. Resolving ways to work within any new regulation with the approval of the Senior Manager as well as coordinating any testing or move to production efforts as it applies to hospital and physician billing functions as well as denial resolution workflows. Review all billing/payer edits and reason/remark codes to ensure there are continual updates. The Manager will also work closely with the Senior Manager to maintain appropriate files, reports and other statistical data as required and provide results of all special projects and provide recommendations for additional revenue opportunities. Coordinates re-bills and adjustments of accounts based on hospital and physician audit results.
The Manager will work closely with all Patient Access Staff, Contracting and Process Improvement, Revenue Cycle Division staff, Medical Records staff, patients and hospital and physician staff. The Manager will coordinate activities with other departments as approved by the Senior Manager and is expected to demonstrate, through plans and actions, that there is a consistent standard of excellence
Associate Degree and/or 3 to 5 years related work experience
Bachelor's Degree and/or 5 years related work experience
Three to Five years of leadership experience in a directly related role.
National Correct Coding Initiative edits, LCD, MUE and physician/inpatient and outpatient hospital billing requirements.
Thorough knowledge of Electronic Data Interchange (270/271, 276/277, 837, and 835 ANSI program transactions)
5 years of experience in hospital and physician billing.
Database software, Strong knowledge of documentation requirements, Computer skills including word processing, spreadsheets, Internet and Intranet software, e-mail.
Mission Health, based in Asheville, North Carolina, is the state’s sixth-largest health system and the region’s only not-for-profit, independent community hospital system governed and managed exclusively in western North Carolina. Mission Health was recognized as one of the nation’s Top 15 Health Systems from 2012-2015 by Truven Health Analytics, formerly Thomson Reuters, becoming the only health ...system in North Carolina to achieve this recognition. Mission Health, which traces its roots in the region back to 1885, operates six hospitals, numerous outpatient and surgery centers, post-acute care provider CarePartners, long-term acute care provider Asheville Specialty Hospital and the region’s only dedicated Level II trauma center. Its medical staff consists of more than 1,000 physicians and is certified in more than 50 medical specialties and sub-specialties. Mission Health has seven Centers of Excellence: Cancer, Heart, Mission Children’s Hospital, Neurosciences, Orthopedics, Trauma and Women’s Health. Mission Hospital, located in Asheville, is the system’s flagship hospital and is licensed for 763 beds. It is the regional referral center for tertiary and quaternary care. It also includes Mission Children’s Hospital – the region’s only children’s hospital. Other Mission Health member hospitals include Angel Medical Center in Franklin, Blue Ridge Regional Hospital in Spruce Pine, Highlands-Cashiers Hospital in Highlands, McDowell Hospital in Marion and Transylvania Regional Hospital in Brevard. With approximately 10,700 employees and 2,000 volunteers, Mission Health is dedicated to improving the health and wellness of the people of western North Carolina.