Manager, Hospital/Professional Insurance Follow-Up - Revenue Cycle HB Billing & Denials

Minimum Qualifications:

Must have at least 5 years of related experience in Hospital/Professional revenue cycle environment and at least 3 years of management experience.

Preferred Qualifications:

Bachelor’s degree in finance or related field, 10 years of related experience in revenue cycle environment. Experience in an academic teaching environment. Proven track record building strong departments and teams. Knowledge of Epic Patient Accounting System

Job Summary:

The Manager of Hospital/Professional Insurance Follow-Up coordinates and directs all Hospital/Professional accounts receivable management activities related to insurance balances. The Manager ensures accurate and timely follow-up on all Hospital/Professional accounts UTMB and that appropriate actions are taken to ensure reimbursement. This position is responsible for ensuring that policies and procedures within the Revenue Cycle are complied with in accordance with all Federal and State guidelines. The Manager of Hospital/Professional Insurance Follow-Up oversees the Hospital/Professional follow-up team under Revenue Cycle Operations (RCO) including team leads and specialists (denials/follow-up). The Manager interacts with UTMB leadership, including clinical and finance. External contacts consist of insurance companies, state and federal agencies, auditors, and vendors. The Manager is responsible for managing accounts receivable critical key indicators.

Essential Job Functions: 

• Responsible for managing Hospital/Professional accounts receivable and ensuring that all transactions are posted accurately.
• Responsible for timely and accurate account resolution, including payer appeals for all denials and underpayments.
• Collaborates and communicates with all levels of leadership throughout the organization on denials trends and opportunities for maximizing reimbursement.
• Responsible for the coordination and provision of personnel and capital resources for Hospital/Professional Insurance Follow-Up team.
• Provides guidance and instruction in the interpretation of policies, procedures, and regulations.
• Identifies appropriate internal controls for department; provides mechanisms to monitor and enforce compliance.
• Develops, coordinates, and implements Hospital/Professional accounts receivable management and revenue cycle activities related to UTMB Hospitals, including vendor activities.
• Monitors changes in Federal Regulations and advises departments on the impact of pending regulation changes. Establishes policy to ensure compliance with all federal regulations and insurance company requirements related to the revenue cycle for UTMB Hospitals.
• Interacts with multidisciplinary personnel, including Chairmen, Institutional Leadership, Department Managers, etc., to ensure that processes are developed and maintained to maximize Hospital/Professional reimbursement to UTMB Hospitals.
• Develops plans for recruitment and retention of direct subordinates and oversees the recruitment and retention of management and operational staff.
• Works closely with contracting to ensure optimal payer contract terms, and is responsible for ensuring the appropriate collection of all payments due under the terms and conditions of those contracts.
• Serves as key contact to Revenue Integrity Team for all Hospital/Professional insurance follow-up items related to gross revenue capture and net revenue opportunity.
• Identifies and initiates improvements/efficiencies to the revenue cycle for hospital/technical revenue.
• Responsible for monitoring and managing Hospital/Professional Accounts Receivable (AR), including outstanding claims, underpayments, and denials and ensures these meet organizational and industry standards.

Marginal or Periodic Functions: 

Other duties as assigned.

Knowledge/ Skills/ Abilities: 

• Knowledge of federal and state collection laws, Medicare, Medicaid, and other third-party pay or regulatory requirements.
• Thorough knowledge of Hospital/Professional reimbursement and managed care contract issues.
• Knowledge of automated systems that support Hospital/Professional billing services.
• General knowledge of medical terminology and trends.
• Knowledge and detailed understanding of all negotiated agreements.
• Strong communication and interpersonal skills with a high degree of professionalism in dealing with staff at all levels of the institution.
• Excellent relationship-builder and communicator and extensive knowledge of health care operations.
• Effective problem-solving skills.
• Ability to develop, prioritize, and accomplish goals.
• Ability to analyze and evaluate data and make appropriate decisions/recommendations.
• Ability to effectively manage different level staff and delegate responsibilities/tasks.
• Demonstrated project management and performance improvement skills.