Billing Operations Manager
Brown Emergency Medicine (Brown EM) is the academic emergency medicine physician practice plan of the Department of Emergency Medicine at the Alpert Medical School of Brown University. Brown EM provides emergency department staffing for Rhode Island Hospital, the only Level I trauma center in this region; Hasbro Children’s Hospital, Rhode Island’s only children’s specialty hospital; The Miriam Hospital, a leading community teaching hospital and Newport Hospital, a community Magnet Hospital. Brown EM member physicians and providers treat over 250,000 patients per year at our 4 clinical sites, drawing patients from Rhode Island, Massachusetts and Connecticut. As a non-profit foundation, Brown EM is committed to its mission and vision of academic and research support. Brown EM offers an excellent benefits package, including 85-90% employer-paid medical and dental, vision, employer-paid life insurance, long-term disability, paid time off, paid holidays and generous 401(k) retirement plan.
Brown EM is looking for a Billing Operations Manager who would be responsible for coordinating all direct patient and third-party billing and reimbursement functions to ensure prompt payment of accounts and optimal reimbursement.
The Billing Operations Manager will report to the Revenue Cycle Director and will be based in Providence. The position responsibilities will be customized to the qualifications of the person filling the role. Other responsibilities may include:
- Directs and participates in Brown EM’s day-to-day operation related to patient billing and collections procedures/systems.
- Coordinates and oversees computer systems as they relate to patient billing, monthly closing and related functions; implements changes to systems as necessary.
- Responds to inquiries and requests from patients and resolves as authorized, when needed.
- Oversees collections of receivables, application and deposit of cash, follow-up billing, maintenance of related records and accounts.
- Responsible for month-end closings and for supervising and preparation of monthly and yearly computer reports.
- Maintains current knowledge of patient reimbursement issues impacting upon Brown EM’s billing operations.
- Maintains Billing Department Policies and Procedures Manual and ensures that all policies and procedures are adhered to.
- Deals with third-party payor representatives and provider services to solve large-scale billing issues.
- Oversees application process.
- Ensures HRO credentialing system is up to date.
- Supervises CAQH process.
- Works with MSO, physicians and payors to assure timely and uninterrupted credentialing of providers.
- Responsible for supervision of the Medical Billing Team including but not limited to: assisting HR in hiring qualified candidates, training new hires, conducting annual performance evaluations, and recommending disciplinary related personnel actions to supervisor and Human Resources.
- Responsible for supervision of the Credentialing Department.
- Keeps current with medical compliance and reimbursement policies, such as medical necessity issues and correct coding issues,
- Maintains compliance with payor reimbursement policies and governmental regulations as well as Medicare/CMS guidelines.
- Monitors progress resulting from periodic internal audits.
- Oversees prepared and/or submission of all completed claim forms for services and procedures performed by the medical providers.
- Oversees explanations of benefits from payors, evaluating denied claims and filing appeals for denied claims.
- Provides current data for reports to the Revenue Cycle Director as needed.
- Attends internal/external meetings/trainings related to areas of responsibility, when necessary.
- Assists with external auditors’ requests, if needed.
- Attendance at various committee meetings as required.
- Meets with supervisor on a regular basis for supervision.
The qualifications for the position are:
- A minimum of an Associate Degree in Medical Office Procedures, Business Management or related field and 5 years of patient account experience. Bachelor’s degree preferred.
- Knowledge of ICD-9 CM, ICD-10, CPT-4 Coding, and medical terminology.
- Must submit a background release form and demonstrate proof of being free from disqualifying information.
- Experience with practice management systems is required.
- Experience in the complete revenue cycle of a large medical practice.
- Supervisory experience required.
- Cordial telephone etiquette and courteous demeanor.
- Must possess good customer service skills.
- Demonstrates ability to clearly communicate verbally and in written form.
- Ability to prioritize and organize a variety of tasks to support departmental needs.
- Good computer skills required. Working knowledge of Microsoft Office, with a proficiency in Microsoft Excel.
Successful candidate must submit to a background release form, demonstrate proof of being free from disqualifying information and must possess a driver’s license and access to an insured vehicle as some transportation may be required. All requirements are subject to possible modification to reasonably accommodate individuals with disabilities. Some requirements may exclude individuals who pose a direct threat or significant risk to the health and safety of themselves and others. Brown EM is an equal opportunity employer. We strive to provide a workplace free from harassment. For more information about Brown EM, please visit our website at https://brownphysicians.org/brown-emergency-medicine/.