Medicare Billing And Follow-Up Manager (Manager, Patient Business Services)

As the Manager of Medicare Billing, Follow-up, and Compliance, you are responsible for the general management of personnel responsible for the Billing and collection of Medicare receivables, including planning, organizing, directing, controlling, and evaluating all facets of personnel and operations for OHSU Health including any system partners. Accounts receivable collections include inpatient and outpatient primary billing, secondary billing, hospital-based physician billing (professional fees), adjustments to claims, third-party reimbursement, capitation, contractual and financial policy administration, and the resolution of credit balances. Within this position, you are also responsible for coordinating with Quality Assurance, Utilization Review, HIS, and professional review organizations for CMS-mandated reviews, the hospital admits for which retroactive authorization is requested, etc. The primary focus is efficient and effective management of accounts receivable to achieve the correct reimbursement consistent with government regulations, industry standards, and payer contracts.

• Plan, organize, assign, review, and evaluate work of staff related to Medicare accounts receivable collections to include inpatient and outpatient primary billing, secondary billing, hospital-based physician billing (professional fees), adjustments to claims, third party reimbursement, capitation and contractual and financial policy administration.
  • Coordinate with Quality Assurance, Utilization Review, HIS and professional review organizations for CMS mandated reviews, hospital admits for which retroactive authorization is requested, etc.

• Responsible for final review of all Charge Description Master adds and changes for assignment of correct coverage pointers, CPT and HCPCS codes and revenue codes.

• Monitor and evaluate current reimbursement/payment rules and ensure that legislative and regulatory changes impacting medical billing are anticipated and communicated to the clinical faculty, staff and department billing personnel.
  • Disseminate regulatory information as appropriate within Patient Business Services, Enterprise Coding, Hospital Financial Services, Patient Access Services, Care Management/Utilization Review and other areas as affected

• Administrative functions include budgeting for areas of responsibility, productivity management, personnel management, quality control, developing and managing goals, objectives, and benchmarks for all functions within areas of responsibility. 

  • Responsible for resolving credit balances, issuing refunds for areas of responsibility within required timelines specified by Medicare.

  • Responsible for filing the Medicare Quarterly Credit report per CMS regulations.

• Coordinate with the Office of Integrity and Office of Legal Affairs to execute any compliance projects.

  • Track and monitor compliance projects, working with the clinical departments as necessary.

• Respond to audit needs for Medicare.

  • Resolve discrepancies with payers. Respond to State/Federal subpoenas.

  • Work with Office of Integrity and legal counsel on investigations. Supervise Audit Coordinator position responsible for all third-party audits, retrieval of medical record information for all PBS staff and

    verification of charges questioned by patient.

• Responsible for PBS cost reporting duties:

  • Assist Hospital Financial Services as needed with annual Medicare Cost Reports.

  • Analyze Medicare accounts for write-off, covered versus noncovered, per regulations.

  • Supervise and coordinate preparation of annual Medicare Bad Debt Log included in the Cost Report. Review all transactions for accuracy.

Education:

• B.S./B.A. or advanced degree

Experience:

• 5 years of hospital billing management and automated systems experience; 
• 3 years of current Medicare program knowledge and experience (within the last 3 years)
• 5 Years of progressive supervisory experience to include recruitment, termination, and discipline of personnel

Job Related Knowledge, Skills and Abilities:

• Customer service experience;must possess exellent interpersonal/listening skills to interact effectively with individuals of all backgrounds, experience and educational levels 
• Extensive third party collection experience
• Thorough knowledge of reimbursement methodologies 
• Recent Microsoft Office Word & Excel experience in Windows environment (within 2 years of date of hire)
• Familiarity with medical terminology
• Record of effective collaboration, to ensure success in achieving hospital or system performance targets. 
• Verifiable record of accomplishment in meeting performance hurdles for improving cash collections.
• Knowledge of DRG, CPT, HCPCS, ICD9/ICD10 coding and CCI, OCE, OPPS edits.
• Must be able to perform the essential functions of the position with or without accommodation.

Frequent meetings with hospital/clinics/department personnel (on and off campus). Periodic external

meetings with Medicare. Frequent travel to OHSU campus for meetings.

 

Pay Range: $81,619 - $130,374 annually

Oregon Health & Science University values a diverse and culturally competent workforce. We are proud of our commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation contact the Affirmative Action and Equal Opportunity Department at 503-494-5148 or aaeo@ohsu.edu.