Payer Manager

Role Description

Manage teams both internally and externally with the goal of driving timely and accurate Accounts Receivable resolution. Regularly review and provide solutions to further increase the effectiveness of both internal and external teams. Maintain and recommend on key metrics in support of Simon Med business goals. Drive value by optimizing cash flow, cash timing and collections. Quickly identify opportunities as they arise and work resolutions as far upstream as possible to prevent further incursions.

LOCATION: Remote

Travel % (if applicable): 10-20%

Essential Functions

• Provide day-to-day supervision of front and back-end functions, including authorizations, billing, and AR.
• Review/oversee charges to ensure complete and accurate capture of charges for batch reconciliation.
• Review/oversee prior authorizations as required by the patient's insurance carrier and coordinate with clinicians, hospital staff, and third-party authorization vendors to track and communicate authorization status and billing requirements supported by SOP(s) creation.
• Review AR reports to identify payer trends, issues and aged A/R and work with payors on coverage limitations and other needs.
• Keep informed regarding current billing requirements and company/department policies and procedures as it applies to the field of all modalities and effectively apply this knowledge.
• Work and/or maintain accounts in AR.
• Instruct the team responsible for carrier/patient follow (AR aging).
• Review and respond to carrier correspondence via mail/email/portal/lockbox.
• Assist with third party payor and other audit requests.
• Review and approve write off adjustments for accounts as needed.
• Review and approve refund requests and send to AP department for processing monthly.
• Perform site visits for Front end process review and other projects related to billing compliance in fulfillment of the practice's compliance program.
• Root Cause Analysis/Resolution.
• Denial Management.
• Assist in developing and executing educational plans related to clinical related denials.
• Assist in the development of procedure manuals/SOPs related to billing compliance.
• Monitor and report volume of work as well as any outstanding issues to applicable manager.
• Assess workflow and develop strategy to complete all necessary work prioritizing tasks as necessary.
• Review & approve employee time for semi-monthly payroll.
• Monitor overtime.
• Manage employee activity such as the interview process, job performance, and quarterly performance reviews.
• Manage employee relations issues appropriately as they arise and escalate to manager as necessary.

Reporting

• Maximize IT system integrations for EMR and Practice Management system.
• Work with onshore and offshore team members to enhance A/R collection speed and increase efficiency.
• Work with vendors to further utilize technology enhancements and increase effectivity and reduce cost of collections.
• Regularly assess team capabilities and talent gaps. Build learning plans and growth opportunities within to grow capabilities and ensures accurate, timely results and solutions.
• Work across departments (both internal and external) and levels thereof to apply data-driven improvements to all aspects of the end-to-end process.
• Provide accurate read outs of RCM performance and opportunities.
• Adhere to policies, procedures, guidelines relative to departmental operations.
• Additional responsibilities may be assigned to help drive our mission of improving the patient journey.

Essential Competencies

• Attendance is an essential job function.
• Excellent written and verbal communication skills with the ability to effectively communicate and establish collaborative relationships with physicians, patients, clinical and administrative staff, and the public.
• Excellent customer service skills with the ability to process patient and public inquiries, including complaints, and respond with poise and efficiency.
• Knowledge of clinic office procedures, prior authorizations, and medical billing guidelines.
• In depth understanding of Managed Care Organizations and payer guidelines.
• Knowledge of clinic office procedures, medical practice and medical terminology.
• Ability to interpret, adapt and apply guidelines and policies and procedures.
• Ability to successfully organize, delegate, and supervise.
• Ability to recognize, evaluate and solve problems.
• Ability to successfully plan, implement and manage multiple projects simultaneously.
• Strong organizational skills and attention to detail.
• Ability to work remotely.
• Strong knowledge of Windows-based software applications. (E.g.: Word, Excel, Outlook...)
• Excellent Customer Service skills.

Minimum Qualifications

• Education: Bachelor's degree preferred.
• Experience: 5+ yrs of Revenue cycle leadership.
• 3+ years of data analytics and automation.
• Offshore Vendor management preferred.
• Coding experience preferred.
• Radiology billing experience preferred.
• Data Analytics preferred.
• Imagine experience preferred.

Physical Demands

This position may require duties including lifting and carrying up to 40 pounds, sitting for prolonged periods of time, with frequent standing and walking.

Benefits

• Your health, happiness and future matters! At SimonMed Imaging, we offer medical, vision and dental insurance.
• 401(k) eligibility.
• Paid holidays plus PTO.
• Sick Time.
• Opportunity for growth.
• Much more!

Dress Attire

Business Casual or scrubs dependent on department.

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. Employment is contingent upon successful completion of drug and background screening. Some positions will require a favorable driving record.