Office Manager - Nexus Physician Services

Job Description

Job Description

POSITION SUMMARY:

The Nexus Physician Services Office Manager oversees the daily operations, administrative functions, and revenue cycle activities of physician practices within a specialty hospital system serving individuals with neurodevelopmental disorders, autism spectrum disorder, intellectual and developmental disabilities, traumatic brain injury, and complex medical and behavioral conditions. The role ensures efficient practice operations, exceptional patient and family experiences, regulatory compliance, and optimal financial performance. Working collaboratively with physicians, clinical teams, and operational leaders, the Manager drives service excellence, revenue integrity, quality outcomes, and continuous process improvement. The position serves as a key liaison between providers, staff, patients, caregivers, and support departments to support accessible, patient-centered, and financially sustainable care delivery.

JOB-SPECIFIC RESPONSIBILITIES:

• Service 

o Consistently supports and communicates the Mission, Vision, and Values of Nexus Health Systems

o Upholds the Standards of conduct and corporate compliance

o Demonstrates honest behavior in all matters. To the best of the employee’s knowledge and understanding, complies with all Federal and State laws and regulations.

o Maintains the privacy and security of all confidential and protected health information. Uses and discloses only that information which is necessary to perform the function of the job.

o Adheres to all Nexus Health Systems policies on Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)

o Collaborates effectively with colleagues and other departments to ensure seamless service delivery.

o Oversee day-to-day operations of physician offices including scheduling, registration, referrals, prior authorizations, insurance verification, medical records coordination, payment posting, and patient access functions.

o Direct and supervise front-office, administrative, patient access, and billing support personnel.

o Develop, implement, and monitor workflows that improve operational efficiency, reduce patient wait times, and enhance provider productivity.

o Collaborate with physicians, advanced practice providers, nursing, therapy, behavioral health, and care coordination teams to promote integrated care delivery.

o Ensure staffing schedules support patient volume demands while maintaining appropriate service levels.

o Lead patient access initiatives to improve timely appointments and continuity of care for medically and behaviorally complex patients.

o Serve as operational liaison between physician practices, hospital departments, referral sources, payers, and community providers.

o Manage office resources, supplies, equipment, and vendor relationships to support efficient operations.

o Facilitate resolution of operational concerns, patient complaints, and service recovery opportunities.

o Support organizational strategic initiatives and physician practice growth opportunities.

• Excellence 

o Establish performance standards and accountability measures for physician office operations.

o Monitor operational metrics including scheduling utilization, provider productivity, access-to-care indicators, referral conversion rates, and patient throughput.

o Develop and maintain standard operating procedures that promote consistency and reduce process variation across physician service locations.

o Utilize PDCA, and continuous improvement methodologies to improve operational performance and patient outcomes.

o Prepare operational dashboards, performance reports, and executive summaries for leadership review.

o Monitor workflow effectiveness and identify opportunities for automation, standardization, and process improvement.

o Foster a culture of accountability, teamwork, professionalism, and service excellence.

o Ensure accurate maintenance of provider schedules, clinic templates, referral management systems, and electronic health record workflows.

o Support physician recruitment, onboarding, credentialing coordination, and practice integration activities.

• Patient Experience and Advocacy 

o Promote a patient-centered environment that recognizes the unique communication, behavioral, sensory, developmental, and medical needs of patients with neurodevelopmental disorders and traumatic brain injury.

o Ensure staff utilize trauma-informed, family-centered, and neurodiversity-affirming engagement practices.

o Monitor patient satisfaction, grievance trends, and patient feedback to identify improvement opportunities.

o Develop service standards that promote dignity, respect, accessibility, and equitable care.

o Collaborate with clinical teams to address barriers impacting access, communication, treatment adherence, or coordination of care.

o Ensure accommodations are implemented for patients requiring behavioral supports, communication assistance, or individualized care approaches.

o Advocate for patients and caregivers throughout scheduling, referral, registration, billing, and care coordination processes.

o Lead service recovery efforts and resolution of patient concerns in a timely and professional manner.

• Quality Assurance and Compliance: 

o Ensures all activities adhere to healthcare regulations and organizational policies.

o Participates in quality improvement initiatives to enhance service delivery.

o Promotes a culture of patient safety which results in the identification and reduction of unsafe practices.

o Ensure physician office operations comply with HIPAA Privacy and Security Rules, CMS requirements, payer regulations, state healthcare regulations, and organizational policies.

o Oversee compliance with documentation, registration, consent, authorization, release of information, and patient financial responsibility requirements.

o Monitor adherence to Medicare, Medicaid, commercial insurance, and managed care payer guidelines.

o Collaborate with compliance, health information management, coding, and revenue cycle teams to support auditing and corrective action initiatives.

o Ensure accurate implementation of CPT, HCPCS, ICD-10-CM, modifier usage, and payer billing requirements.

o Monitor denial trends and implement corrective actions to reduce compliance and reimbursement risks.

o Support organizational compliance programs, internal audits, risk assessments, and regulatory surveys.

o Participate in incident reviews, root cause analyses, performance improvement projects, and corrective action plans.

o Ensure staff complete mandatory annual compliance, privacy, fraud and abuse, and patient safety training.

o Maintain readiness for accreditation and regulatory surveys including DNV, CARF, The Joint Commission, CMS, and state regulatory agencies as applicable.

o Promote ethical billing practices and adherence to federal fraud, waste, and abuse prevention standards.

• Professional Growth and Continuing Education:

o Completes annual education requirements.

o Maintains competency, as evidenced by completion of competency validation requirements.

o Maintains competency and knowledge of current standards of practice, trends, and developments.

o Participates in relevant workshops, seminars, and continuing education courses to stay current with industry trends, healthcare regulations, and best practices.

o Recruit, onboard, mentor, and develop physician office personnel.

o Conduct performance evaluations, coaching sessions, competency assessments, and corrective action processes when necessary.

o Establish individual development plans for direct reports.

o Provide ongoing education related to revenue cycle management, customer service, compliance, payer requirements, and operational excellence.

o Encourage participation in professional organizations, educational programs, and industry certifications.

o Support workforce development initiatives focused on specialty populations including autism, IDD, behavioral health, and traumatic brain injury.

o Maintain current knowledge of healthcare regulations, physician practice management trends, reimbursement methodologies, and industry best practices.

o Promote interdisciplinary collaboration and professional accountability across departments.

• Finance: 

o Promotes stewardship of hospital resources while ensuring quality patient care.

o Oversee physician practice revenue cycle operations including charge capture, billing, claim submission, payment posting, denial management, accounts receivable follow-up, collections, and patient financial services.

o Monitor key revenue cycle indicators including:

 Days in Accounts Receivable

 Net Collection Rate

 Gross Collection Rate

 Clean Claim Rate

 First Pass Resolution Rate

 Denial Rate

 Bad Debt Percentage

 Cash Collections

o Analyze reimbursement trends and payer performance to identify opportunities for revenue optimization.

o Ensure timely claim submission and resolution of payer denials.

o Collaborate with coding, compliance, and billing personnel to improve revenue integrity and billing accuracy.

o Develop action plans to reduce aged accounts receivable and improve collection performance.

o Monitor operational expenses and identify cost-saving opportunities without compromising service quality.

o Assist with budget development, forecasting, productivity analysis, and financial performance reporting.

o Support contract management initiatives and physician practice financial sustainability.

o Ensure adherence to revenue cycle management best practices consistent with AAHAM standards and industry benchmarks.

• Performs other duties as assigned. 

POSITION QUALIFICATIONS:

EDUCATION: 

• Bachelor's degree in Healthcare Administration, Business Administration, Healthcare Management, Finance, Public Health, or a related field required.

• Master's degree in Healthcare Administration (MHA), Business Administration (MBA), or related healthcare field preferred.

EXPERIENCE: 

• Minimum of five (5) years of progressive experience in physician practice operations, ambulatory care operations, medical office management, or healthcare administration required.

• Minimum of three (3) years of leadership or supervisory experience required.

• Experience managing provider practice operations, revenue cycle activities, and administrative staff required.

• Experience working with specialty populations, behavioral health, developmental disabilities, autism spectrum disorder, or traumatic brain injury populations preferred.

• Experience with electronic health records, practice management systems, scheduling platforms, and revenue cycle technology required.

• Experience with Medicare, Medicaid, managed care, and commercial payer processes required.

SKILLS:

• Advanced physician practice operations management.

• Revenue cycle management and accounts receivable expertise.

• Strong leadership, coaching, and staff development skills.

• Financial analysis, budgeting, and performance reporting.

• Knowledge of healthcare compliance, privacy, and regulatory requirements.

• Process improvement and Lean methodology application.

• Effective conflict resolution and service recovery skills.

• Strong oral, written, and interpersonal communication abilities.

• Strategic planning and problem-solving capabilities.

• Ability to manage multiple priorities in a complex healthcare environment.

• Strong analytical and data-driven decision-making skills.

• Proficiency with EHR, practice management, scheduling, billing, and reporting systems.

LICENSURE/CERTIFICATION:

• Current Healthcare Compliance, Revenue Cycle, or Practice Management certification obtained within two years of hire if not currently held, required.

• Must maintain current certification in good standing during employment with this facility.