Responsible for maximizing the collection of medical services payments and reimbursements from patients, insurance carriers, financial aide, and guarantors
Responsible for insurance eligibility processes, charge processing, claim submission and processing, payment processing, collections and accounts receivable management, denial management, reporting of results and analysis, concurrent and retrospective auditing, proper coding, credentialing, insurance contract review and oversight, customer services relative to revenue cycle, training and development relative to revenue cycle, analytics, and all other revenue cycle management activities
Supports and adheres to the US Oncology Compliance Program, to include Code of Ethics and Business Standards, and US Oncology's Shared Values
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Management oversight of all business related functions of the patient visit from point of entry to accurate adjudication of the patients' accounts
Specific areas of responsibility include Revenue Cycle Training, Credentialing Registration, Claims Management, Billing, Collections, Patient Insurance, Data Processing, Integrity of Patient Accounts, Accounts Receivable Management, practice management system file maintenance, and third party revenue cycle vendors
Responsible for provider reimbursement programs, policies, and strategies to ensure unit cost controls meet or exceed corporate objectives for medical cost containment
Analyzes claims, utilization, and medical cost data
Develops strategic, cost effective programs, and makes system or network changes to enhance competitive position
Monitors aged accounts and verifies appropriate collections procedures are being followed
Manages revenue cycle projects at the Practice level, such as audits and budgets
Regularly provides upper management with revenue cycle status including reports, metrics, and presentations
Develops, monitors, and assesses business metrics in order to refine processes and improve efficiencies
Establishes internal goals and identifies external benchmarks
Resolves escalated reimbursement issues with Payors, Practice , US Oncology, and systems for optimal management of accounts receivable
Challenges the status quo and champions new initiatives
Acts as a catalyst of change and stimulates others to change
Paves the way for needed changes
Manages implementation effectively
Steps forward to address difficult issues
Puts self on the line to deal with important problems
Develops, implements, and maintains the Practice's revenue cycle standard operating procedures (SOPs)
May develop training materials and facilitate staff training of SOPs, systems, metrics, government regulations and etc.
Responsible for the overall coordination of front office duties to include scheduling, check-in, and co-pay/co-insurance collection
Identifies goals and vision for team
Guides individuals and teams toward priorities
Clarifies roles and responsibilities of others
Coordinates resources and arranges organizational systems to meet objectives
Develops and implements progressive short-term goals that align with the company's vision and business goals
Cascades goals down to staff's annual objectives
Attracts high caliber people
Accurately assesses strengths and development needs of employees
Gives timely, specific feedback and helpful coaching
Provides challenging assignments and opportunities for development
Responsible for interviewing, recommending hires, assessing performance, recommending salary changes, and progressive discipline
Enforces adherence to the Practice's and US Oncology's policies
Performs other duties as requested or assigned
Bachelors degree in Finance, Business, or equivalent OR 8 years of revenue cycle management experience required
At least four (4) years of medical revenue cycle management experience required with a consistent track record of achieving metrics and at least two (2) years supervisory experience successfully resolving a variety of people issues
Overall revenue cycle experience should exceed nine (9) years.
Individual must have strong knowledge of medical insurance billing and collections with CPT, ICD9, and HCPC coding and medical terminology, as well as an overall understanding of managed care products (HMO, PPO, etc.)
Proficiency in Microsoft Office (Outlook, Excel, Word, and PowerPoint)
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. The position requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. The position requires standing and walking for extensive periods of time. The employee occasionally lifts and carries items weighing up to 40 lbs. The position requires corrected vision and hearing to normal range.
The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.
The US Oncology Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
Internal Number: MCKEA00878022
About US Oncology Network
The US Oncology Network believes local cancer care is better care. We empower the delivery of advanced integrated cancer care through our network of independent physicians who share expertise and resources to provide quality, value-based care close to home.
Our clinical and business support capabilities, expertise and industry-leading technologies keep local practices at the forefront of high quality, efficient care delivery while enabling practice success, quality of life and financial security for physicians.
- 25 years of oncology practice management expertise
- Leader in value-based cancer care with over 900 physicians participating in the Center for Medicaid and Medicare
- Innovation Oncology Care Model – one fourth of the entire population of physicians nationwide
- Over 1,400 affiliated physicians
- More than 450 cancer treatment center locations across the United States
- Over 995,000 patients treated annually