The site navigation utilizes arrow, enter, escape, and space bar key commands. Left and right arrows move across top level links and expand / close menus in sub levels. Up and Down arrows will open main level menus and toggle through sub tier links. Enter and space open menus and escape closes them as well. Tab will move on to the next part of the site rather than go through menu items.
Develop, plan, organize, and implement current and future strategies for coding, billing, accounts receivable management and collections.
(This list may not include all assigned duties)
Directs the functions of billing, coding, charge entry, payment posting, and accounts receivable for Prevea service areas.
Develop and monitor business office key performance indicators (KPI’s). Compares and analyzes to industry standard benchmarks.
Updates CFO of key trends, KPI’s, changes to third party payment policies and regulations.
Establishes annual strategic plan for the business office. Quarterly update to CFO on progress and obstacles.
Continuous improvement in policies and procedures.
Implement and communicate policies, procedures, and strategies.
Works closely with Prevea’s Compliance Officer to ensure continuous compliance with established policies, billing practices, and coding.
Create and promote efficiency of business office staff and functions.
Develop and implement controls and measures to ensure accurate and timely billing and collections, in accordance with established internal and third-party payer requirements.
Oversees all payer contract analysis.
Ensure reimbursements are contractually accurate by analyzing expected vs actual payments for all major payers.
Identify and analyze accounts receivable issues, reporting findings to CFO.
Monitor credit balances on patient accounts.
Develops annual department budget.
Manages the business office within the established budget.
Partnering with Front End Revenue Director to ensure efficiencies within both departments, reduce errors, and address obstacles collaboratively.
Partnering with Front End Revenue Director to ensure timely collections from patients and reduction in errors that prevents accurate billing and payment delays.
Analyze workflow and demand within the business office and set the organizational structure to meet this demand.
Establish industry standard metrics for all business office functions.
Manage actions relating to delinquent accounts, collection agencies, adjustments and write-offs.
Ensure appropriate training of all business office staff.
Continuously ensure all business office staff are competent in their roles.
Oversees performance of business office managers.
Maintains knowledge of and compliance with laws, regulations, policies, and procedures.
Maintains and establishes clinic chargemaster.
Annual review of clinic chargemaster and recommends changes to insure maximum reimbursement from payers while setting competitive prices for certain services.
Participates in Compliance Committee.
Co-chairs Revenue Cycle Committee with Front End Revenue Director. Establishes agenda, encourages participation, update Committee members on key trends in Revenue Cycle.
Work in partnership with HSHS hospital billing staff as needed.
Maintains confidentiality in accordance with HIPAA regulations.
Participates in professional development activities and maintains professional affiliations.
Performs related work as required.
Development of strategic plan for business office with quarterly updates.
Monitor key industry trends in workflows, efficiencies, software development, etc and recommends proactive changes within the department.
Proficiency in business office operations and ability to use computerized systems to manage the clinic's business information.
Ability to lead a large departmental staff. Knowledge of medical business office procedures.
Knowledge of medical coding. Knowledge of third party payor operating procedures.
Communication with CFO on KPI’s, payer trends, payer actions.
Ability to maintain confidentiality of sensitive information.
Ability to effectively interact with patients, physicians, employees, and leadership and respond with poise and efficiency.
Ability to recognize, evaluate and solve problems, and correct errors.
Skill in establishing and maintaining effective working relationships with other employees, patients, organizations and the public.
Minimum Bachelor's degree in business administration or related field required. Master’s Degree preferred.
Minimum of ten years medical business office experience including six years in a supervisory or managerial role.
Internal Number: BOD1020
About Prevea Health
Founded in Green Bay, Wis. in 1996, Prevea Health is a health care organization that provides high-quality, primary and specialty health care in 80+ locations across Northern, Eastern and Western Wisconsin in clinic and hospital settings. It is partnered with six Hospital Sisters Health System (HSHS) hospitals across Wisconsin to provide patients a system of highly-coordinated care, close to home: HSHS St. Vincent Hospital and HSHS St. Mary’s Hospital Medical Center in Green Bay; HSHS St. Nicholas Hospital in Sheboygan; HSHS St. Clare Memorial Hospital in Oconto Falls; HSHS Sacred Heart Hospital in Eau Claire; and HSHS St. Joseph’s Hospital in Chippewa Falls. For more information, visit www.prevea.com.