Biller/Collector III

Revenue Cycle Lead

The Revenue Cycle Lead functions as the subject matter expert. The Lead is responsible for assisting the supervisor and staff with workload and productivity management as well as new employee training. This individual is also responsible for collaborating with other departments to continuously improve revenue cycle performance by identifying, communicating, and resolving issues with the supervisor. The Revenue Cycle Lead will also provide leadership and guidance to the staff through knowledge of the company's internal policies and procedures in addition to industry standard billing and collection guidelines. The individual in this role works in a team environment to fulfill the mission and goals of the Division. This role is knowledgeable and supports the different functions within Revenue Cycle including but not limited to collections, data processing, payment posting, refunds, coverage validation and billing.

General Responsibilities:

• Initiates proactive measures that result in developing policies, policy changes and policy implementation.
• Assists supervisor in developing goals, monitoring work queues, and distributing assignments to staff.
• Helps to monitor performance and identify areas in need of improvement.
• Interacts with co-workers, managers and other representatives to complete projects and tasks.
• Responds timely and accurately to all incoming related correspondence and inquiries from payers, patients and other authorized parties.
• Reports any trends supervisor/manager for appropriate follow-up.
• Assists supervisor in hiring and training new staff, developing training materials, and provides ongoing instruction to staff as needed.
• When required, may assist with providing feedback on staff conduct.
• Respond to all emails and phone calls from other divisions, patients or insurance companies in an efficient and courteous manner.
• Maintains compliance with HIPAA guidelines and ensures staff maintain discrepancy when handling patient information.
• Demonstrates teamwork and provides assistants with special projects when assigned.
• Maintains a positive image when dealing with departmental personnel and other City of Hope employees.

Essential Functions:

• Generates monthly work files for staff based on monthly review of volume and internal policies and procedures or as needed.
• Facilitates communications with payers to address outstanding claims, denials, or remits to resolve payment variances, and works to develop and maintain positive relationships with payers.
• Initiates communications with providers to address any outstanding issues impacting revenue; makes recommendations for resolving and/or improving the flow of data and maximizing charge capture.
• Reviews denial reason codes and underpayments to identify root causes; works with payer contracting and other areas of the revenue cycle if necessary to resolve issues.
• Analyzes data to track and identify trends and provides team with updates and ideas for improvement.
• Assists staff in identifying high-risk accounts and prioritizing resolution efforts; Ensures staff is researching high dollar accounts, high volume denials, credits, adjustments, and undistributed balances, etc. in adherence to internal policies and procedures.
• Maintains superior understanding of CPT/HCPCS codes, ICD-10 codes, CMS 1500 form guidelines, eligibility and coverage requirements, remit and remark codes, payor/plan codes, claims management, third-party payer guidelines, state and federal regulations, claims clearinghouse workflow, and all other pertinent functions of the job.
• Has thorough knowledge of managed care contracts, DOFRs, reimbursement rates, and other billing requirements mandated by said agreements with payors.
• Collaborates with other departments to identify best-practice strategies, align goals, and improve collections.
• Ensures staff is working work queues in adherence to internal policies and procedures.
• Ensures that all necessary documentation and information is correct according to divisional policies and procedures for approval of charge corrections and refunds.

Follows established City of Hope and department policies, procedures, objectives, performance improvement, attendance, safety, environmental, and infection control guidelines, including adherence to the workplace Code of Conduct and Compliance Plan. Practices a high level of integrity and honesty in maintaining confidentiality. Performs other related duties as assigned or requested.

Position Qualifications:

• Minimum Education: High school diploma or equivalent
• Minimum Experience: Minimum of seven (7) years of experience performing medical billing functions.
• Minimum experience includes corresponding with insurance companies in resolving patient accounts.
• Extensive knowledge of insurance carrier procedures, including Medicare, Medi-Cal and other third-party payors.
• Experience with reading Explanations of Benefits (EOB) statements.
• Proven ability to handle multiple conflicting tasks.
• Required Courses/Training:
• Req. Certification/Licensure:
• Preferred Education: Associates or bachelor's degree preferred
• Preferred Courses/Training: Pref. Certification/Licensure:
• Preferred Experience:
• Skills/Abilities:
• Demonstrated knowledge of claims review and analysis; ICD-10, CPT, and HCPCS coding; and medical Terminology
• Effective communication, leadership, organizational, and problem-solving skills
• Ability to manage multiple tasks and projects simultaneously
• Ability to analyze data, identify improvement, and implement change
• Demonstrated written and verbal communication skills.
• Ability to plan and carry out responsibilities with minor supervision
• Excellent verbal and written communication skills
• Excellent interpersonal skills with customer service focus
• Software: Experience with on-line practice management system.
• Knowledge of PC based software applications.
• Proficient in MS Office, specifically MS Word, Power Point, and Excel (e.g. Word for Windows, Excel, etc.) is required.
• Machines/Equipment: Personal computer Computer peripheral equipment
• Working / Environmental Conditions: Atmosphere and environment associated with an office setting. Smoke free environment
• Subject to regularly changing priorities and work assignments
• Physical Demands: Light physical effort Mostly sedentary work Occasional standing/walking