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Orthopedic Revenue Cycle Manager

Location: Medford
Posted on: September 14, 2023

Job Description:

This position is responsible for managing the orthopedic billing and revenue cycle processes within both Beth Israel Deaconess Medical Center (BIDMC)/Harvard Medical Faculty Physicians (HMFP) Department of Orthopedics and Physicians Professional Services (PPS) with special attention to billing outcomes and coding performance. This includes working with the Orthopedic Departments administrative and operational team and physicians to assure optimum revenue cycle performance.
Primary Responsibilities: 1. Manages the day to day billing operations within the PPS Orthopaedic Department 2. Manages the Orthopedic revenue cycle pre-billing systems to assure that all pre-billing systems at HMFP and collection systems at PPS work together seamlessly. This includes working closely with the Department administrative management team and both Department and Hospital-based insurance referral capture management, and self-pay collection systems to help continuously improve them.3. Oversees orthopedic coding systems to ensure timely and accurate entry for all surgical services provided. Responsible for denial work file management, creating an environment where accounts receivable staff are motivated to ensure claims processing occurs in a timely and accurate manner.4. Directs all A/R and collection teams to align goals and objectives, for both health insurance and Workmans Comp, to maximize their contribution to client Net Collection Rate and A/R metrics performance. 5. Ensures that all necessary training for Orthopaedic revenue cycle staff (PPS and BIDMC) occurs effectively on a timely basis.6. Responsible for driving process improvement initiatives related to revenue cycle functions, in collaboration with the Orthopaedic Department administrative management.7. Analyzes month end reports to identify opportunities for work process improvements with respect to claims denials.8. Responsible for claim edit work file oversight by Orthopaedic revenue cycle staff (both PPS and BIDMC), ensuring timely submission of charges.9. Serves as a key resource for changes in orthopedic payment and coding guidelines from all payers. Educates PPS staff, Orthopaedic Department staff and physicians as necessary.10. Establish strong relationships with payer representatives to quickly mitigate any payer issues with ongoing barriers to payment.11. Analyzes monthly appeals reports, tracking work effort by the PPS billing staff to ensure collections activity on a regular basis. Analyzes weekly charges and payments data to ensure PPS billing staff is on track to meet established targets for productivity. Reviews denial trends to determine/address payer problems. Coordinates efforts regarding authorization issues.12. Conduct revenue cycle meetings with individual orthopedic physicians as required to present and review individual revenue and A/R metrics and provide timely follow-up to their questions and ideas.13. As requested. present revenue cycle performance tracking results to the HMFP Department of Orthopedics faculty showing trending of key metrics, analysis of variances from targets and improvement plans and progress on prior improvement plans.14. Works cooperatively with BIDMC and HMFP compliance staff to ensure revenue cycle systems in the Department are meeting compliance standards for all internal and external accountabilities. Required Qualifications: Bachelor's degree required. Minimum three years of relevant professional component revenue cycle management experienceThree years of supervisory/management experience required Current knowledge of ICD?10 and CPT coding systems and principles

Keywords: PHYSICIANS PROFESSIONAL SERVICES, LLP, Medford , Orthopedic Revenue Cycle Manager, Executive , Medford, Massachusetts

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